Evolving Role of Lymphedema Surgery on Breast Reconstruction: A Systematic Review and Multi-Institutional Algorithmic...

Area of Science:

• Oncology
• Plastic Surgery
• Lymphedema Management

Background:

• Increased breast cancer survival necessitates focus on post-treatment complications like lymphedema.
• Lymphatic surgery plays an evolving role in breast reconstruction, yet its current application lacks comprehensive evaluation.
• Limited literature exists on the integration of lymphatic surgery within breast reconstruction protocols.

Purpose of the Study:

• To systematically review and evaluate the current state of lymphatic surgery in breast reconstruction.
• To analyze various surgical techniques employed in lymphatic reconstruction.
• To propose a framework for a multi-institutional algorithmic approach to lymphatic surgery in breast reconstruction.

Main Methods:

• A systematic literature search and screening process was conducted.
• Data extracted included study type, surgical procedure (bypass, pLVB/ILR/LYMPHA, VLNT, combination), and clinical outcomes.
• 184 studies were included in the systematic review.

Main Results:

• Publications on lymphatic surgery increased significantly from 4.4/year (2010-2016) to 21.1/year (since 2017).
• Vascularized lymph node transfer (VLNT) was the most published procedure (34.6%), followed by preventive lymphatic surgery (31.4%).
• Since 2020, preventive surgery and combined lymphatic surgery with breast reconstruction have seen increased research focus.

Conclusions:

• The role of lymphatic surgery in breast cancer patients is expanding, with growing emphasis on preventive and combined reconstructive strategies.
• Current literature predominantly consists of lower-level evidence.
• There is a critical need for more randomized controlled trials to establish robust clinical recommendations for lymphatic surgery in breast reconstruction.