Lymphedema

The lymphatic system, part of your circulatory system, removes interstitial fluid from tissue, transports fatty acids from your digestive system, transports white blood cells to and from your lymph nodes to the bones and stimulates your immune system. Lymphedema occurs when your lymphatic system is blocked somewhere in your body, preventing lymph fluid from draining properly.

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Symptoms

The symptoms of lymphedema can be sudden onset or appear over time. 

In addition to swelling or discomfort in the area of the blockage, symptoms of lymphedema include:

  • Numbness or a tight feeling around the swollen area.
  • Loss of mobility or flexibility due to swelling.
  • Signs of infection: fever, redness, warmth, tenderness around the swelling.

Causes of Lymphedema

Lymphedema can be either primary, where there is no underlying cause, or secondary, where it is a result of lymph vessels or nodes that were removed, scarred or damaged, typically after surgery. Infection, cancer and radiation treatments for cancer also put you at risk for lymphedema. In rare situations, lymphedema occurs as a result of inherited conditions that can present at any time during your life.

Lymph node(s) removal as a result of breast cancer surgery is common. Without sufficient lymph nodes to drain the lymph fluid, lymphedema may occur under the arm.

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Diagnosis

A visual examination is the most common method of diagnosing lymphedema.Your doctor will check for tenderness and swelling and range of movement. If the visual diagnosis isn’t clear, your doctor may order one or more of the following diagnostic procedures:

  • Lymphosynctigraphy, an injection of radioactive dye into your veins. A scanning device will show the doctor how the lymph fluid is traveling through your body.
  • MRI (magnetic resonance imaging), which will give your doctor a 3-dimensional visual of the area of swelling.
  • CT (computerized tomography) scan, which may reveal where your lymphatic system is blocked.
  • Ultrasound, which is helpful in finding obstructions.
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Treatments

If non-invasive treatments such as elevation of the swollen extremity or compression bandages and garments do not provide relief, massage therapy may be helpful. If these treatments do not work, surgery may be recommended.

There are two primary surgical techniques to treat lymphedema:  vascularized lymph node transfer and lymphaticovenous anastomosis. The physicians at the Center for Plastic and Reconstructive Surgery at Cedars-Sinai are experts in both advanced microsurgery and super microsurgery techniques that are required for these delicate and precise surgeries.

Vascularized Lymph Node Transfer

During vascularized lymph node transfer, used primarily for treating upper extremity lymphedema, the surgeon will:

  • Harvest lymph nodes from another area of your body, together with its supporting artery and veins.
  • Replace the lymph nodes that were removed with the harvested lymph nodes, artery and veins.
  • Remain aware not to harvest so many lymph nodes that you are at risk in the harvested area.

Over time, the transferred lymph nodes will develop their own, new, circulatory system and the lymph fluid will begin draining properly.

Lymphaticovenous Anastomosis

The lymphaticovenous anastomosis procedure differs from vascularized lymph node transfer in that it is slightly less invasive. Rather than harvest lymph nodes from another area of the body, the lymphatic vessels in the affected area are reconnected to nearby veins, allowing for the necessary paths to develop so the fluid drains. This procedure may be done on an outpatient basis.