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Dr. juhi

Dr. Juhi Agrawal
Consultant
Onco-Reconstructive Surgery
BLK Cancer Centre
BLK Super Speciality
Hospital, New Delhi

Dr.Kapil

Dr. Kapil Kumar
Director - BLK Cancer Centre
HOD - Surgical Oncology
BLK Cancer Centre

Dr. Sandeep Mehta
Assistant Director
Surgical Oncology
BLK Cancer Centre



Prevention is better than cure

A new approach towards Breast Cancer related
Lymphedema

Lymphedema is a chronic debilitating condition characterised by massive limb swelling causing heaviness, discomfort, decreased limb mobility and increased susceptibility to infections. With the increased life expectancy of Breast Cancer survivors, Lymphedema is emerging as a significant cause of morbidity in such survivors. It causes functional, cosmetic and psychological problems resulting in a negative impact on the overall quality of life. Once Lymphedema is established, it becomes difficult to achieve positive outcomes.

Breast Cancer related Lymphedema (BCRL) is caused due to Axillary Lymphadenectomy done as a part of Breast Cancer surgery. Sentinel Lymph Node Biopsy has reduced the incidence of BCRL but not omitted its occurrence. The incidence of BCRL is four times higher in patients undergoing complete axillary clearance when compared with Sentinel Lymph Node Biopsy alone (19.9% vs 5.6%). The prevalence of Lymphedema in Breast Cancer survivors varies from 6% to 50%. The risk factors for development of Lymphedema are extent of Axillary Lymphadenectomy, Radiotherapy, taxane-based Chemotherapy and Obesity.

The recent developments in the field of Lymphedema surgery are focusing towards its prevention, especially those caused by cancer treatment. Many studies have shown promising results when the lymphatics draining the arm are salvaged by letting them drain into the systemic circulation (blood) by performing Lymphovenous Anastomosis in the axilla.This concept is oncologically safe and restores the physiology of the lymphatic system of the ipsilateral arm which is disturbed by Axillary Lymphadenectomy.

At BLK Cancer Centre, “Lymphovenous Anastomosis” are performed at the time of axillary dissection to prevent Lymphedema occurrence. The lymphatics draining the arm are identified in the axilla by giving a blue dye in the proximal arm. During axillary dissection, a branch of the axillary vein is preserved with good length. The identified lymphatics are then anastomosed to the vein preserved by ‘dunking’ method where 3-4 lymphatics are together inserted into the venous lumen. The incision is then closed over suction drains in the usual manner with routine post-operative care.

BLK has performed 25 surgeries till date and has a maximum follow-up of 9 months where none of the patients have shown development of Lymphedema. The intended follow-up is with Lymphoscintigraphy during the completion of treatment.