Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Microsurgery. 2023 May;43(4):387-391. doi: 10.1002/micr.31004. Epub 2023 Jan 16.
Breast lymphedema is a type of breast cancer related lymphedema that leads to significant discomfort and negative impact on body image. Conservative therapy and lymphovenous bypass have been previously described as possible treatment methods for breast lymphedema, however, a unified approach to treatment is lacking. The current report describes a case of breast lymphedema successfully treated with vascularized lymph node transfer (VLNT) after failed attempt at management with conservative therapy. The patient is a 48-year-old female with right-sided breast cancer who underwent breast conservation therapy in 2015 and subsequently developed pain and swelling of the right breast. The diagnosis of breast lymphedema was supported by clinical evaluation as well as MRI, lymphoscintigraphy, and lymphography. In consultation with a breast surgeon, breast lymphedema was determined not to be an indication for mastectomy. The patient was offered and underwent an omental VLNT to the right breast. A 20 cm segment of omentum with associated gastroepiploic vessels and lymph nodes was harvested, transferred to the right axilla and gastroepiploic vessels were anastomosed to the recipient thoracodorsal vessels. The patient tolerated the procedure well and there were no complications. Additional donor sites were considered, such as the groin and submental regions, but an omental flap was favored in this case because of the lower risk of donor site lymphedema. In the years following, the patient reported significant improvement in symptoms as well as objective reduction of edema on MRI. We propose the consideration of VLNT for breast lymphedema refractory to other methods of management.
乳房淋巴水肿是一种乳腺癌相关的淋巴水肿，会导致显著的不适和身体形象的负面影响。保守治疗和淋巴静脉旁路已被描述为治疗乳房淋巴水肿的可能方法，但缺乏统一的治疗方法。本报告描述了一例乳房淋巴水肿患者，在保守治疗失败后，成功接受了带血管化淋巴结转移（VLNT）治疗。患者为 48 岁女性，右侧乳腺癌，于 2015 年接受保乳治疗，随后出现右侧乳房疼痛和肿胀。临床评估以及 MRI、淋巴闪烁显像和淋巴造影支持乳房淋巴水肿的诊断。与乳腺外科医生会诊后，认为乳房淋巴水肿不是乳房切除术的指征。为患者提供并进行了右侧乳房网膜 VLNT。取 20cm 长的网膜段及其相关胃网膜血管和淋巴结，转移至右侧腋窝，胃网膜血管吻合至受体胸背血管。患者耐受良好，无并发症。还考虑了其他供体部位，如腹股沟和颏下区域，但在这种情况下，网膜皮瓣更受欢迎，因为供体部位淋巴水肿的风险较低。在随后的几年里，患者报告症状显著改善，MRI 显示水肿明显减轻。我们建议对其他治疗方法无效的乳房淋巴水肿考虑 VLNT。
