Putting an end to lymphoedema

Thanks to medical advances in the treatment of breast cancer, 90 per cent of patients survive. But despite the removal of the tumour, many women suffer from troublesome side effects. "One of the most common problems is lymphoedema, a chronic and often painful condition that causes swelling in the limbs due to the build-up of lymph fluid. It is particularly common in women who have had lymph nodes removed or damaged during breast cancer surgery," explains Prof. Dr Mario Scaglioni, Co-Chief Physician at the Plastic Surgery Pyramid in Zurich.

The lymphatic system forms an integral part of the immune system and is made up of delicate lymphatic vessels and lymph nodes. Its main functions include the elimination of harmful cells and the transfer of white blood cells. This makes the lymphatic vessels an important part of the immune system. According to estimates by the Swiss Lymphoedema Association, around 50,000 to 100,000 people in Switzerland live with lymphoedema. " Lymphoedema can occur anywhere on the body where lymph nodes have been removed or irradiated. However, this does not happen immediately after the operation. The symptoms develop over weeks or months and can even occur years after cancer treatment," says Prof Scaglioni.

Stages of lymphoedema

There are three stages of lymphoedema. In the third stage, the swelling is permanent, but surgery is still possible.

Lymphoedema manifests itself in the form of visible and palpable swelling in the arms or legs, a feeling of tightness, especially when wearing tight-fitting clothing. Other symptoms include obvious and prolonged pressure points, thickening or hardening of the skin, dull pain in the affected areas and small blisters from which a clear fluid emerges. Untreated lymphoedema does not simply disappear, but increases slowly but steadily. The combination of lymphatic drainage and compression therapy is standard in the conservative treatment of lymphoedema. "At an advanced stage, lymphoedema cannot be cured, but we can improve the quality of life through conservative treatment," explains Prof Mario Scaglioni. If detected early and corrected by surgery, the vascular disease can even be cured.

With the help of microsurgery and supermicrosurgery, it is possible to restore the lymph flow. "Lymphovenous anastomosis, or LVA for short, is a bypass. We connect the lymphatic vessels to a vein, which improves lymphatic drainage. The procedure is performed under a microscope. We use contrast agents to check whether the connection is working," says Prof Scaglioni. The procedure can be carried out at any point where the lymph is disturbed. "In the case of advanced lymphoedema, we achieve a reduction in swelling of up to 40 per cent. After that, conservative measures such as lymphatic drainage or compression are also reduced." An anastomosis is not enough in cases of prolonged oedema where fibrosis of the tissue has already taken place. "In this case, an additional transfer of tissue containing lymph nodes is required. Lymphovenous anastomosis is then usually added to optimise drainage."

Lymphoedema testimonials

One testimonial shows that the procedure works: Emergency physician Dr Dorothée Rhein Straub relies heavily on her hands and arms. A few months after her breast cancer operation, she developed lymphoedema in her right arm. Shortly afterwards, she was operated on by Prof Scaglioni and received six bypasses during the first operation. At her request, further bypasses were placed in a second operation. Five years later, there is no sign of the severe swelling. She is working as a doctor again.

An 86-year-old patient with secondary lymphoedema on her right arm, stage II: before the operation (left image) and 12 months after the operation (right image).

Leo Clodius Lymphatic Centre: The top address for lymphatic problems

Switzerland's first private lymphatic centre, part of the Plastic Surgery Pyramid, specialises in lymphatic diseases and sophisticated, super-microsurgical reconstruction of the lymphatic system. The naming of the centre after the famous surgeon PD Dr. med. Leo Clodius was a deliberate choice. Leo Clodius was an important plastic surgeon and pioneer in lymphoedema research. He defined the principles of modern lymphatic surgery, according to which operations are still performed today. In his spirit, the new centre also offers a fellowship programme to support young doctors.

Contact:

Leo Clodius Lymphatic Centre
Plastic Surgery Pyramid
House to the Pyramid
Klausstrasse 10, 8008 Zurich

Phone: +41 44 388 14 14
E-mail: psp@pyramide.ch
Website: www.pyramide.ch