The breast cancer‐related lymphedema multidisciplinary approach: Algorithm for conservative and multimodal surgical treatment

Abstract Background Multiple surgical alternatives are available to treat breast cancer‐related lymphedema (BCRL) providing a variable spectrum of outcomes. This study aimed to present the breast cancer‐related lymphedema multidisciplinary approach (B‐LYMA) to systematically treat BCRL. Methods Seventy‐eight patients presenting with BCRL between 2017 and 2021 were included. The average age and BMI were 49.4 ± 7.8 years and 28.1 ± 3.5 kg/m 2 , respectively. Forty patients had lymphedema ISL stage II (51.3%) and 38 had stage III (48.7%). The mean follow‐up was 26.4 months. Treatment was selected according to the B‐LYMA algorithm, which aims to combine physiologic and excisional procedures according to the preoperative evaluation of patients. All patients had pre‐ and postoperative complex decongestive therapy (CDT). Results Stage II patients were treated with lymphaticovenous anastomosis (LVA) ( n = 18), vascularized lymph node transfer (VLNT) ( n = 12), and combined DIEP flap and VLNT ( n = 10). Stage III patients underwent combined suction‐assisted lipectomy (SAL) and LVA ( n = 36) or combined SAL and VLNT ( n = 2). Circumferential reduction rates (CRR) were comparable between patients treated with LVA (56.5 ± 8.4%), VLNT (54.4 ± 10.2%), and combined VLNT‐DIEP flap (56.5 ± 3.9%) ( p > .05). In comparison to LVA, VLNT, and combined VLNT‐DIEP flap, combined SAL‐LVA exhibited higher CRRs (85 ± 10.5%, p < .001). The CRR for combined SAL‐VLNT was 75 ± 8.5%. One VLNT failed and minor complications occurred in the combined DIEP‐VLNT group. Conclusion The B‐LYMA protocol directs the treatment of BCRL according to the lymphatic system's condition. In advanced stages where a single physiologic procedure is not sufficient, additional excisional surgery is implemented. Preoperative and postoperative CDT is mandatory to improve the outcomes.