The Lymphedema Institute
at the Center for Restorative Breast Surgery
What is Lymphedema?
The “lymphatic system” is a collection of tiny tubes found in the skin and soft tissue of our arms/legs and torso that drain naturally occurring excess fluid from those areas as we go through ordinary activities of daily living. These “tubes” drain into “nodes” which are small lumpy filters that clear the fluid of bacteria and other impurities as it drains back into the circulatory system. Lymphedema is what occurs when the fluid no longer drains properly through this system. It results from damage to the “tubes” and “nodes” and causes the areas that were once drained properly to swell. Lymphedema is most frequently seen after breast cancer treatments such as arm pit lymph node dissection surgery and/or radiation therapy, which can damage the lymphatic system of the arm. Chronic swelling, discomfort, and skin infections are among the symptoms that may be improved with proper therapy, including massage, compression, and in some cases, microsurgical repair as part of your overall lymphedema treatment program.
The Lymphedema Institute
The Center for Restorative Breast Surgery is world renowned for our pioneering work in the field of breast reconstruction. Our approach to lymphedema follows the same philosophy, with comprehensive and innovative methods to address one of the least understood and often most neglected side effects of breast cancer treatment. The Lymphedema Institute, within the Center for Restorative Breast Surgery, is the first dedicated and comprehensive lymphedema treatment program of its kind in the world. It was founded to provide singular focus to the full spectrum of modern options available to provide relief from what can be a functionally debilitating condition long after your breast cancer treatments end.
We focus on full service solutions for improvement, ranging from lifestyle counseling, massage therapy, compressive garment fitting, and surgical management strategies. Our newest state of the art Functional Axillary Reconstruction procedure is among these, as well as, Lympho-venous Bypass and Lymph Node Transplant procedures.
As the saying goes, “prevention is worth a pound of cure”. The Lymphedema Institute’s therapy division includes our dedicated Physical Therapist with specialized training in lymphedema care and prevention. She visits with all of our patients undergoing mastectomy to provide instruction, massage therapy, and post-care planning to minimize your chance of developing lymphedema. She also directs the pre and post-care regimen for those undergoing surgical procedures for lymphedema correction.
Our Surgical Oncologists are experts at “lymphatic mapping” and use specialized equipment to direct precision lymphatic protection during mastectomy/lymph node excisions and biopsy. These extra steps help minimize your chances of developing lymphedema during your recovery from mastectomy when lymph node sampling is recommended.
Our Reconstructive Surgeons are expert at transplanting living tissue into the lymph node dissection site when breast reconstruction is part of your treatment program. Natural tissue breast reconstruction has been proven over many years to provide superior protection against lymphedema compared to implant breast reconstruction techniques.
For those who are candidates for our Functional Axillary Reconstruction “FAR” protocol, we begin by releasing tight, scarred tissue in the arm pit from previous surgeries and/or radiation treatments. This can improve range of motion, reduce tethering, improve comfort, and prepare the area for contour restoration and filling with our innovative “Dermo-Lymphatic Transplantation Procedure” or Lymph Node Transplantation.
For those who need additional filling and lymphatic flow restoration in the armpit after mastectomy and/or radiation therapy, a rich source of oxygen, living fat, and dermal lymphatic flow is added to the area once scar adhesions and tethering are addressed with micro-releases under high power magnification. We utilize the “TDAP Flap” to provide this living “dermo-lymphatic” transplantation. This rich source of “dermal lymphatics” helps to increase lymphatic flow, restore oxygenation, prevent reoccurrence of scarring, while adding fullness and softness to an excavated arm pit.
This transplant is taken from excess fat along the “bra-roll” which eliminates the risk of taking lymph nodes from another area as is done in Lymph Node Transplantation. An added benefit of Dermo-Lymphatic Transplantation can be improved contour in the donor site as well as a full, soft addition to the transplant site. This approach is a logic based therapy to not only improve lymphedema symptoms but also address overall Functional Restoration with improved range of motion, added contour, and improved softness to reduce pain and pressure points.
Axillary Hair Removal
Another component of our Functional Axillary Reconstruction protocol is the utilization of laser hair removal in the arm pit to eliminate the need to shave. This can help when areas of numbness are present and contours are not smooth. Elimination of the need to shave may help reduce the risk of nicks and cuts that can lead to infection. It also can improve general quality of life by permanently removing hair from the affected surgical sites.
Lymph Node Transplantation
For some patients, a Vascularized Lymph Node Transplantation (“VLNTx”) may be the option of choice. While carrying some minor risk to the area where lymph nodes are harvested, the benefit of living lymph node transplantation may offer the opportunity for lymphedema improvement. Your surgeon at the Lymphedema Institute will review all options with you and make the appropriate recommendation based on your unique needs and circumstances.
Christopher G. Trahan, MD, FACS
David S. Cabiling, MD
M. Whitten Wise, MD
Sarosh Naz Zafar, MD
Kristin Kitchen, MPT, CLT
At our Lymphedema Institute, the first dedicated and comprehensive lymphedema treatment program of its kind in the world, we provide evaluation and treatment for those affected by arm swelling post mastectomy. We focus on full service solutions for improvement, ranging from lifestyle counseling, massage therapy, compressive garment fitting, and surgical management strategies. Among these, are our newest state of the art “Dermo-Lymphatic Functional Axillary Reconstruction” procedure, as well as, Lympho-Venous Bypass and Lymph Node Transplant procedures.
The First Dedicated and Comprehensive Lymphedema Treatment Program of Its Kind in the World.
In the past, Lymphedema Treatment has largely been limited to conservative management interventions including manual lymphatic drainage therapy, compression garments, bandaging, and pneumatic pump devices.
Our Functional Axillary Reconstructive program, revolutionary Dermo-Lymphatic Transplantation, and Vascularized Lymph Node Transfer (VLNTx) procedures for lymphedema can be performed when combined with any reconstructive breast surgery or as follow-up treatment to a previous surgery.
“Lymphedema – the worst side effect I’ve had – has been virtually eliminated thanks to these forward-thinking doctors”
Breast Cancer Survivor
Dr. Cabiling joins breastcancer.org to discuss Managing Life With Lymphedema.