New surgical program treats breast cancer-related lymphedema

Monday, November 4, 2019

Greenwich, CT (Nov. 4) – Greenwich Hospital has launched an innovative surgical program to treat breast cancer-related lymphedema, a chronic condition that can significantly impair an individual’s health and mobility long after completing cancer treatment. “We are excited to bring cutting edge surgery to our breast cancer patients,” said Norman G. Roth, the hospital’s president and chief executive officer. The advanced procedure is performed by Andreas M. Lamelas, MD, a plastic surgeon who focuses on natural tissue breast reconstruction. Dr. Lamelas – with colleagues David Greenspun, MD and Heather Erhard, MD – modeled the new program after a similar one at Harvard University, where Dr. Lamelas completed a fellowship.

What is lymphedema?

The body has a network of lymph nodes and lymph vessels that collect fluid, waste material and other substances located outside the bloodstream. While veins collect and carry blood throughout the body, lymph vessels carry a clear watery fluid called lymph.

“Lymphedema is an abnormal swelling that can develop in the limbs when lymph nodes are removed during surgery to check for cancer or when the lymph nodes are damaged by radiation therapy,” said Dr. Lamelas. “The lymph vessels can no longer carry all the fluid away, which leads to a build-up beneath the skin. Lymphedema surgery can improve quality of life by alleviating swelling and symptoms.”

The debilitating and painful condition, which one study estimates occurs in up to 40 percent of breast cancer patients, can develop years after cancer treatment.

Lymphedema treatment options

Greenwich Hospital’s comprehensive lymphedema program – which includes surgical and non-surgical treatment options – brings together specialists from reconstructive plastic surgery, breast surgery, physical medicine, physical therapy, radiology and nuclear medicine. Patients with mild to moderate lymphedema may benefit from a lympho-venous bypass procedure, which re-routes lymphatic fluid from the dysfunctional lymphatic channels into circulatory system veins. This outpatient procedure, performed through several small incisions, requires highly specialized instruments and microscope because the rerouted lymphatic vessels are less than 1 millimeter in diameter (about the size of the tip of a ballpoint pen).

“A recent development has been prophylactic lympho-venous bypass, which involves performing the bypass procedure at the same time that the lymph nodes are removed,” said Dr. Lamelas. “Early studies of this technique show promising results with a decreased risk of developing lymphedema in these patients.”

A free lymph-node transfer
may be suitable for patients with more severe cases. In this procedure, properly functioning lymph nodes are transplanted from another part of the body and reconnected to tiny blood vessels in the affected limb using a surgical microscope. These new lymph nodes, which are prepared with arteries and veins to establish blood flow, can help improve lymphatic function to reduce symptoms. Patients stay in the hospital for two to three days to closely monitor blood flow to the transplanted lymph nodes.

Patients can also tap non-surgical treatments on an outpatient basis, including “complete decongestive therapy” or CDT, which combines bandaging, lymphatic drainage and compression garment fitting to decrease swelling. These services are provided by specially trained lymphedema therapists, who work with patients to create individualized treatment plans.

Greenwich Hospital is a member of Yale New Haven Health. Greenwich is a 206-bed (includes 32 isolettes) community hospital serving lower Fairfield County, Connecticut and Westchester County, New York. It is a academic affiliate of Yale School of Medicine. Since opening in 1903, Greenwich Hospital has evolved into a progressive medical center and teaching institution representing all medical specialties and offering a wide range of medical, surgical, diagnostic and wellness programs. Greenwich Hospital is recognized throughout the healthcare industry as a leader in service and patient satisfaction excellence. Greenwich Hospital has the prestigious Magnet designation from the American Nurses Credentialing Center, the nation’s highest honor of nursing excellence.

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