After evaluating your lymphedema, surgery may be recommended by your physician. They will decide on the most suitable treatment plan for you, sometimes employing a combination of treatments.

Preventative lymphatic bypass or immediate lymphatic reconstruction, is a new way of treatment in breast cancer related lymphedema. During the removal of breast cancer and axillary clearance, this surgery can be performed to reduce the risk of developing lymphedema. This can be performed either as Lymphatic Microsurgical Preventative Healing Approach (LYMPHA) in the axilla, or Distally-based Lymphatic Microsurgical Preventative Healing Approach (dLYMPHA) in the upper limb. In a chronic disease such as lymphedema, prevention is often better than cure.

LVB is recommended to treat early stage lymphedema where swelling is predominantly caused by fluid accumulation. LVB is a minimally invasive procedure done under microscopic magnification. Lymphatic vessels in the body are connected to small veins nearby, allowing excess lymphatic fluid to drain directly into the vein and return to the body’s natural circulation. In most cases, immediate results are observed following surgery. It can be performed under local anaesthesia during which you can watch the procedure on a TV screen. It may also be used in combination with other treatments.

Lymph node transfer is useful in patients whose native lymph nodes have been removed due to cancer treatment or whose conditions do not improve significantly after lymphovenous bypass. This procedure involves harvesting lymph nodes from the neck or groin region and transplanting them to the affected area with their blood supply intact. With time, new lymphatic channels grow from the transplanted lymph nodes, to effect lymphatic drainage. It may take up to 2 years for the function of transplanted lymph nodes to take effect.

Liposuction is indicated in patients who show extensive fat accumulation in the affected limb. When lymphatic fluid spills over to surrounding tissue, it can cause inflammation and stimulate the growth of fat cells which present as fat accumulation in the limb. You may have non-pitting edema where it is difficult to press the tissue to create a dent. Magnetic resonance imaging can be used to study the fat content and distribution in the affected limb. Liposuction helps to remove this excess fat to achieve a more complete reduction in limb volume. If you are obese, we recommend weight reduction through exercise and dieting as part of the overall lymphedema treatment.

Charles’ procedure consists of a radical excision of lymphedematous tissue followed by skin grafting. This procedure is reserved for late stage lymphedema where conservative measures no longer work. In late stage lymphedema, the soft tissue has undergone extensive fibrotic changes. Surgery will be able to significantly reduce the limb volume and remove warty skin overgrowths prone to infection and skin breakdown.