Tackling the diversity of breast cancer related lymphedema: Perspectives on diagnosis, risk assessment, and clinical management

Tackling the diversity of breast cancer related lymphedema: Perspectives on diagnosis, risk assessment, and clinical management

by Anna Michelotti, Marco Invernizzi, Gianluca Lopez, Daniele Lorenzini, Francesco Nesa, Alessandro De Sire, Nicola Fusco  

The Breast: April 2019, Volume 44, Pages 15-23

Breast cancer related lymphedema (BCRL) develops as a consequence of surgical treatment and/or radiation therapy in a significant number of breast cancer patients. The etiology of this condition is multifactorial and has not yet been completely elucidated. Risk factors include high body mass index, radical surgical procedures (i.e. mastectomy and axillary lymph node dissection), number of lymph nodes removed and number of metastatic lymph nodes, as well as nodal radiation, and chemotherapy. However, these predisposing factors explain only partially the BCRL occurrence, suggesting the possible involvement of individual determinants.

Chemotherapy port related lymphedema after axillary lymph node dissection

Chemotherapy port related lymphedema after axillary lymph node dissection
The Breast August 2016 Volume 28, Pages 145–147

Turfe Z et al

The Mascagni lymphatic pathway comprises superficial channels along the clavicle that drain upper extremity lymph. A 65 year-old woman with recurrent left breast cancer presented with a non-functioning chemotherapy port in the right deltopectoral groove. She had undergone right mastectomy with axillary lymph node dissection (ALND). After port removal and wound closure she developed right upper extremity lymphedema. Patients who have undergone ALND may depend solely on this pathway for upper extremity lymphatic drainage.

Breast Cancer–Related Lymphedema: Quality of Life after Lymph Node Transfer

Breast Cancer–Related Lymphedema: Quality of Life after Lymph Node Transfer

Plastic & Reconstructive Surgery:  June 2016 - Volume 137 - Issue 6 - p 1673–1680

 

De Brucker, B et al

Background: Breast cancer–related lymphedema affects multiple aspects of patients’ daily lives. The main aim of this study was to assess the impact of vascularized lymph node transfer on the quality of life in patients with lymphedema. Methods: Between 2007 and 2012, 25 female patients with breast cancer–related lymphedema underwent vascularized lymph node transfer. In 22 cases, the patients underwent a simultaneous deep inferior epigastric artery perforator flap breast reconstruction based on the superficial circumflex iliac artery. The influence on quality of life was evaluated using the Upper Limb Lymphedema-27 questionnaire, which includes physical, psychological, and social dimensions. The authors also investigated risk factors for lymphedema, such as body mass index, smoking, age, and time between start of lymphedema and vascularized lymph node transfer, and their impact on quality of life. Results: Twenty-one patients (84 percent) had an improvement of quality of life after vascularized lymph node transfer. The mean physical, psychological, and social scores were significantly improved postoperatively (p < 0.001). Risk factors for the development of lymphedema did not influence quality of life among patients with breast cancer–related lymphedema. Skin infections disappeared in 50 percent of the cases. Eleven patients (44 percent) discontinued compression therapy at a mean postoperative time interval of 29 months (range, 8 to 64 months). In the other patients (56 percent), the average frequency of compression therapy decreased from three sessions to one session per week. Conclusion: Vascularized lymph node transfer significantly improves quality of life among patients with breast cancer–related lymphedema.