Chen, R., Mu, L., Zhang, H., Xin, M., Luan, J., Mu, D., . . . Becker, C. (2014). Simultaneous breast reconstruction and treatment of breast cancer–related upper arm lymphedema with lymphatic lower abdominal flap. Annals of Plastic Surgery, 73, S12–S17. 

To introduce key points relating to lower abdominal flap transplantation with vascularized lymph nodes, and to evaluate the effects of breast restoration or reconstruction and lymphatic transplantation to treat upper-arm lymphedema after breast cancer surgery

Ten patients were recruited with postoperative, breast cancer-related lymphedema. Preoperatively, isotope radiography was used to determine lymphatic return obstruction. Patients were operated on in a standing position. A modified deep inferior epigastric perforator artery (DIEP) or microsurgical transverse abdominal myocutaneous island (TRAM) flap was accompanied by lymphatic tissue. The scar contracture of the axilla was relaxed and patients received abdominal transplantation of the lower abdominal flap with vascularized lymph node. Postoperatively, elastic bandages were applied for one year. Follow-up appointments occurred at one, three, six, and 12 months. The measurement indexes that were used included mid- and upper-arm circumference, clinical symptoms, and lymphoscintigraphy.

• N = 10  
• AGE RANGE = 36–50 years
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Breast cancer-related lymphedema
• OTHER KEY SAMPLE CHARACTERISTICS: All patients had lymphedema for three to five years.

• SETTING TYPE: Inpatient    
• LOCATION: Beijing, China

Controlled clinical trial

• Isotope radiography
• Multidetector-commuted tomography
• Mid- and upper-arm circumference measurement
• Clinical symptoms
• Lymphoscintigraphy

All of the flaps worked. One patient experienced delayed wound healing. There was no obvious improvement in lymphedema in one patient. Seven patients saw improvements in lymphedema clinical symptoms and mean limb perimeter. One patient recovered. The mean reduction was 2.122 cm (SD = 2.331). Limb volume decrease was statistically significant between preoperative and postoperative measures (p < .05).

Abdominal flap transplantation with vascularized lymph nodes and breast reconstruction, paired with treatment to upper-arm lymphedema and the use of elastic bandages as adjuvant treatment, is effective in restoring breast configuration and function.

• Small sample (< 30)
• Risk of bias (no control group)
• Other limitations/explanation: Inconsistent study results, lack of standardized surgical technique, and short follow-up.

This procedure may be effective for treating some women with breast cancer-related lymphedema, and it can guide future research on effective lymphedema therapy and postoperative monitoring.