Combination of lymphovenous anastomosis and lymph node transfer for breast cancer-related lymphedema

With the remarkable advancement of microsurgery, surgical treatment for lymphedema has been increasing, and its good results are well established. However, surgical treatment for advanced-stage lymphedema is still a challenging task. We reviewed several methods of combining lymphovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) in breast cancer-related lymphedema (BCRL) patients. Representative VLNT flap options for BCRL patients include the omental flap, superficial circumflex iliac perforator (SCIP) flap, and deep inferior epigastric artery (DIEA) flap combined with inguinal lymph nodes performed simultaneously with breast reconstruction. The surgical outcome, technical details, and donor site morbidities of each surgical option were reviewed. While all three options show significant surgical benefits, each has its clear advantages and disadvantages. The decision on the surgical method may vary according to the needs of each patient and the clinical situation.