Vascularized Lymph Node Transfer

Dr. Fusi is an established board-certified plastic surgeon who has specialized in breast reconstruction for over twenty years. At Yale Medical School, Dr. Fusi received advanced plastic surgical training and currently teaches as a clinical faculty member. Dr. Craig is also a board certified plastic surgeon who completed her plastic surgery residency at Yale, followed by a fellowship in microsurgery at the top cancer center in the nation, MD Anderson Cancer Center in Houston, where she then taught as an Assistant Professor for a few years prior to joining Dr. Fusi’s practice. Dr. Fusi and Dr. Craig were also trained by Dr. Corrine Becker, one of the world’s foremost experts in vascularized lymph node transfer.

What is a Vascularized Lymph Node Transfer?

Reserved for patients experiencing lymphedema, Vascularized Lymph Node Transfer (VLNT) removes a healthy lymph node, and its blood supply, from one location of the body to replace a missing or damaged lymph node at the recipient site. This surgery has been theorized to stimulate lymphangiogenesis, new lymphatic growth and connection to lymphatic channels of transplanted lymph node to create new pathways for drainage and minimize the symptoms of lymphedema. While there are reports of VLNT with promising results, the surgery is still considered experimental and results may vary.

What is Lymphedema?

Lymphedema is a malfunction of drainage of the lymphatic fluid that results in limb swelling which can progressively increase in size, compromising normal function and increasing the risk of infection as well.

As a progressive condition, lymphedema requires immediate intervention to stave off more severe symptoms such as:

  • Tissue inflammation due to excessive lymph fluid.
  • Firmer, painful limbs.
  • Limbs doubling or tripling in size.

Once Connecticut patients develop the first signs of lymphedema, the condition will advance unless treatment is initiated.

Who Is At Risk for Lymphedema?

Lymphedema is a condition that affects patients who have compromised lymph node function. Factors that increase a patient’s risk of lymphedema are:

  • Lymph node removal as part of your breast cancer treatment.
  • Obesity.
  • Radiation therapy.

While not all breast cancer patients develop lymphedema, a high percentage of patients with lymphedema are breast cancer survivors. This is due to the removal of cancerous lymph nodes in the underarms and radiation therapy.

What Happens During a Vascularized Lymph Node Transfer?

Once you have been diagnosed with advanced stage lymphedema and not responded to more conservative treatment such as non-surgical physical therapy and lymphovenous bypass, the possibility of vascularized lymph node transfer may be considered. During a thorough examination of your affected extremities and consultation with your oncologist, Dr. Fusi or Dr. Craig will evaluate the prognosis for performing surgery.

On the day of your surgery, general anesthesia will be administered and Dr. Fusi or Dr. Craig will:

  • Remove a healthy, intact lymph node and its blood supply from an unaffected area. Taking particular care to avoid other lymph nodes within that area by performing ‘reverse mapping’.
  • Transfer the healthy lymph node to the extremity experiencing lymphedema. In the case of upper extremity lymphedema this will be from the groin to the underarm.
  • Reconnect blood supply to the lymph node using microsurgical techniques.
  • Close the incision to promote healing.

Vascularized lymph node transfer is a complex surgical procedure that requires a hospital stay of 2-3 days after surgery. When deciding on a date for the surgery, keep in mind that you will need time to heal properly before you resume your normal activities.

Combined Breast Reconstruction and Vascularized Lymph Node Transfer

Some Connecticut patients who delay breast reconstruction surgery decide to perform both free flap surgery to restore their breast as well as vascularized lymph node transfer to improve their lymphedema.

When Will the Benefits of Surgery Take Effect?

The purpose of vascularized lymph node transfer is to regrow the lymphatic channels that drain fluid. Growth typically takes several weeks to months for Connecticut patients to experience the benefits of surgery. Once these channels have begun to regenerate, you may notice:

  • Reduction in the size of the extremity affected with lymphedema.
  • Less frequent infections due to proper drainage of lymph fluid.
  • Lower incidence of cellulitis.

This procedure is experimental and results may vary for Connecticut patients. Few reports of VLNT have resulted in complete resolution of lymphedema; however, some patients over time have had improvement in their lymphedema and their quality of life as a result.

To schedule a consultation for treatment of your lymphedema, contact our Connecticut office at 203-458-4444, or our Houston office at 713-346-9909.