Improving Surgery to Lower the Risk of Lymphedema in Breast Cancer: What You Need to Know

October 24, 2023
Ted A. James, MD

Breast Cancer Treatment to Reduce Lymphedema Risk

Breast cancer treatment has made significant strides over the years, but managing potential side effects of treatment remains a key aspect of comprehensive patient care. One such side effect is lymphedema, a condition that can cause uncomfortable swelling in the arm following the removal of lymph nodes in the axilla (i.e., underarm). Here are some of the latest techniques to minimize the risk of lymphedema associated with axillary surgery in breast cancer.

Less is More: How Modern Surgery is Limiting Lymph Node Removal

The best way to avoid lymphedema is to limit the number of lymph nodes removed whenever possible. Recent studies show that less aggressive lymph node surgery can be just as effective in treating cancer while reducing the risk of lymphedema. In cases when a patient's lymph nodes appeared cancer-free at the time of diagnosis, but a few tested positive only after surgery, it may not be necessary to have additional nodes removed. Similarly, in cases where cancer is already present in the lymph nodes at the initial diagnosis, pre-surgery chemotherapy could shrink the cancer enough to avoid more extensive lymph node removal. Both of these strategies are supported by clinical trials and form best practices to reduce the risk of lymphedema while effectively treating the cancer.

Making Better Decisions: A Delayed Approach to Lymph Node Surgery

A delayed sentinel lymph node biopsy offers a more cautious and personalized approach for patients undergoing a mastectomy (i.e. complete breast removal) for Ductal Carcinoma In Situ (DCIS), an early form of non-invasive breast cancer. Traditionally, sentinel nodes are removed during the mastectomy as a precaution in case invasive cancer is later found. However, this can lead to unnecessary removal of lymph nodes in up to 80% of patients, increasing the risk of lymphedema.

The delayed sentinel lymph node biopsy changes this by using a magnetic tracer injected into the breast before surgery. This tracer tags the sentinel nodes, which are then left in place in the axilla. After the breast has been removed during the mastectomy, the breast tissue is analyzed. If invasive cancer is found in the breast, the tagged sentinel nodes can be precisely located and removed. However, if no invasive cancer is present, which is often the case, the tagged nodes are left in place, reducing the risk of lymphedema. This innovative technique allows surgeons more time to make well-informed decisions. It helps patients avoid unnecessary surgery and the associated risks, including lymphedema.

A Safety Net to Prevent Lymphedema: Immediate Lymphatic Reconstruction

In cases where extensive lymph node removal is unavoidable, the risk of lymphedema can be as high as 30%. However, a new procedure called immediate lymphatic reconstruction (ILR) offers a proactive solution. The ILR procedure is performed at the same time as the lymph node removal. This advanced reconstructive technique aims to restore normal fluid flow of the upper arm and avoid lymphedema.

This extra step acts as a safety net, making sure that even if more extensive lymph node surgery is needed, measures can be taken to help reduce long-term side effects. Like the other methods described, immediate lymphatic reconstruction is supported by research. It has become a regular part of how we care for our patients.

In Summary

These advances represent a shift towards more personalized and less invasive breast cancer treatment. They aim to balance effective cancer management with minimizing side effects, improving the patient's quality of life both during and after treatment.

For any questions related to your breast health, make sure to contact your primary care physician or your dedicated BILH breast cancer care team.

Ted A. James, MD, MHCM, FACS, is the Medical Director and Chief Breast Surgical Oncologist at the BIDMC Breast Care Center.