'Does every patient have lymphedema after breast cancer?'
'Can precautions be taken to prevent lymphedema?'
'Why does lymphedema occur in the arm and the arm swells after breast cancer?'
'Does lymphedema regress on its own, what happens if it remains untreated?'
'What options are there for the surgical treatment of lymphedema?'
'Is every lymphedema patient suitable for surgery? ?”
Breast cancer is a very common but generally treatable disease that affects one in every eight women today. However, sometimes patients may need to have their armpit lymph nodes removed and/or receive radiotherapy (radiation therapy) as part of the treatment. After this point, swelling may occur in the arm due to the disease we call lymphedema.
DOES EVERY PATIENT HAVE LYMPHEDEMA AFTER BREAST CANCER?
Breast cancer spreads mainly to the armpit lymph nodes. Therefore, when there is spread here, these glands are removed by surgery. Since the removal of the glands will cause a significant deficiency in the lymph system in that arm, the risk of lymphedema increases significantly. In addition, if the patient receives radiotherapy (radiation therapy), the risk of lymphedema in that arm increases even more as the remaining lymph channels will be negatively affected and blocked. In other words, every patient who has had lymph nodes removed and in addition received radiation therapy is in the risk group for lymphedema.
CAN PRECAUTIONS BE TAKEN TO PREVENT LYMPHEDEMA AFTER LYMPH NODES ARE REMOVED?
Some precautions need to be taken after surgery and throughout life. Some of these include not carrying heavy objects, not doing any work on that arm, manicure and nail cutting procedures should be done carefully and under healthy conditions, lymphedema physiotherapy and lifelong use of special lymphedema compression garments. However, none of these absolutely prevent it, they only reduce the risk. Despite all these precautions, lymphedema may develop.
DOES LYMPHEDEMA REGRESS BY ITSELF, WHAT HAPPENS IF IT IS NOT TREATED?
Lymphedema cannot regress on its own. On the contrary, it is a progressive disease over the years. If left untreated, it is due to lymphedema; thickening in the arm, frequent infections, deterioration of circulation, loss of function in the arm, gradual increase in swelling and severe damage over many years. Complications such as the development of lymphatic vessel cancer, which can be fatal, may occur.
WHAT OPTIONS ARE THERE FOR THE SURGICAL TREATMENT OF LYMPHEDEMA?
Basically, these surgeries are in two groups. Functional and non-functional surgeries. In non-functional surgeries, the goal is to reduce the volume of the arm and make daily life easier. In functional surgeries, the main problem is solved by restoring lymph circulation. Functional surgeries; vascularized lymph node transfer and lymphatico-venular anastomosis. In vascularized lymph node transfer, the lymph nodes in the groin, neck or under the jaw areas, which will not cause any problems where the patient is taken, are transferred to the armpit along with the arteries and veins that feed them. Super or supra microsurgical methods are used. Thus, the missing lymph nodes are replaced and after a while, these lymph nodes begin to function, lymph flow is restored in the arm and the swelling in the arm decreases. In lymphatico-venous anastomosis, the small veins next to the lymph channels (which are lymph vessels as thin as a hair) are opened by super or supra microsurgical method, with the aim of returning the lymph fluid through the venous system. In some cases, these two methods are used together.
IS EVERY LYMPHEDEMA PATIENT SUITABLE FOR SURGERY?
The patient should be evaluated individually. Since the main reason is post-breast cancer, advanced breast cancer patients may not be suitable. In addition, some examinations need to be performed to evaluate which patient is suitable for which method.
As a result, today there are surgical treatment options that can provide a permanent solution to lymphedema that develops after breast cancer. Considering that lymphedema has progressive and serious complications, surgical treatment options should be considered in suitable patients.
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