The body’s lymphatic system is one of the most important parts of the human immune system. Our lymphatic vessels and lymph nodes, bone marrow, tonsils and spleen all serve to keep us healthy. For example, tumour cells are trapped in the lymph nodes, and bacteria and other foreign matter are removed. Metabolic waste products are also transported through the lymphatic system, which runs throughout the entire body. A fluid known as lymph flows from the superficial lymphatic vessels into the deep lymphatic vessels, and from there into the veins. If the lymphatic system gets damaged or blocked, the lymph can no longer drain away, and instead builds up. This build-up of lymph is called lymphoedema and causes swelling in the surrounding tissue. It most commonly affects the arms, legs or genitals.
Primary or secondary lymphoedema
We distinguish between congenital abnormalities of the lymphatic system, known as primary lymphoedema, and secondary lymphoedema. Secondary lymphedema occurs when the lymphatic system has been damaged by tumours or surgery. Women who have had breast cancer surgery or tumour surgery in the pelvis (such as for uterine cancer) are at an increased risk of developing lymphoedema. The incidence of lymphoedema for breast cancer patients has been found to be between 6 and 40 per cent, and for tumour surgery in the pelvis it is between 1 and 47 percent. Overall, it is estimated that around 20 per cent of breast cancer patients develop lymphoedema to varying degrees. Various surgical procedures are used in this regard, especially for patients who have lymph nodes removed from the armpit during breast cancer surgery.
Illustration: Microsurgical lymph node transfer from the groin to the axilla and lymphovenous bypass surgery
In this method, the superficial lymphatic vessels are connected directly to the veins. This allows the damaged lymphatic vessels to be bypassed and lets the lymph flow directly into the venous system. The surgical approach is via superficial incisions of only 2 to 3 cm in length. Supermicrosurgery is used in this method because the lymphatic vessels are only 0.5 mm in diameter.
Vascularised lymph node transfer
In this procedure, several lymph nodes together with skin and fat are removed from the groin area with their own blood vessel system. The scar tissue in the area of the lymph nodes in the armpit is removed, and healthy lymph nodes with their associated fatty tissue are transferred to the armpit area and reconnected using microsurgery. The transplanted tissue is connected to the blood vessels under a surgical microscope. New lymphatic vessels can form during the healing process. This method can be readily combined with a secondary breast reconstruction with tissue from the abdomen (DIEP flap). The choice of technique used depends on the individual case. Sometimes the techniques can or must be combined.