Lymphedema. It is not a disease. It is a condition breast cancer patients can experience. Skill, knowledge, expertise, experience, and compassionate care all matter when you are seeking any treatment for lymphedema. Our guest, Dr. Ramon Garza III, is well-qualified to discuss the topic of lymphedema treatment and surgery and possesses all of those characteristics. This is Episode 15 of the DiepCJourney podcast.
Dr. Garza is a board certified plastic surgeon in San Antonio who practices at PRMA (Plastic Reconstructive Microsurgical Associates) and performs both surgical and non-surgical treatment for those affected by lymphedema. We discuss the value of finding a certified lymphedema therapist. You can search the LANA website for one in your area.
Understanding the Lymphatic System When Considering Treatment and Surgery
The function of the lymphatic system is to move excess fluid out of our bodies. It works in unison with the immune system. It is the mismanagement of fluid that causes lymphedema. Surgery can alter the way the lymphatic system is functioning.
When lymph nodes are taken from the axilla, the armpit area, and lymph nodes are no longer there or scar tissue is created after breast surgery around this incision area, the lymphatic system is no longer functioning the way it should normally function. This is what causes the condition of lymphedema and a back up of fluid in that area. Patients experience swelling, discomfort, heaviness, pain, and sometimes loss of dexterity in their fingers.
Risk Analysis of Lymphedema
I asked Dr. Garza how many patients are affected by lymphedema. He stated the numbers vary in research. The range can be from as little as 5% in some studies and up to 25-30% in other studies. Here are the high-risk factors for lymphedema:
- Having 10 or more lymph nodes removed
- Getting radiation to the breast and axilla area
- Chemotherapy treatment for breast cancer
- A BMI higher than 30
Here are the low risk factors for lymphedema:
- Having a prophylactic mastectomy for high risk of getting breast cancer.
- When the sentinel lymph nodes only are biopsied during breast surgery.
Keep in mind it can happen in the low-risk group but is rare. Dr. Garza emphasizes it is important to communicate with your healthcare team as part of your lymphedema risk management if you are going to need or have radiation, chemotherapy, have more than 10 lymph nodes removed or have a higher BMI.
Post-Surgical Care of Lymphedema Treatment
If you are a patient at high-risk, it is important to seek care from a certified lymph therapist to begin preventative measure to mitigate the conditions of lymphedema. There is certainly no harm in getting plugged in ahead of surgery with a Certified Lymphedema Therapist (CLT) with consideration you may need them post-surgery.
Access to care is critical but can be challenging. We know not every city has a microsurgeon who performs DIEP flap breast reconstruction. It is no different finding a certified lymphedema therapist. There is not one in every area.
The silver lining of the pandemic is we have become savvier at using telemedicine. Although and in-person evaluation is an important piece of the puzzle in lymphedema treatment, a virtual telemedicine consult is certainly better than the alternative which is no care. With a more robust telemedicine system now in place, some instruction can be done over the phone or via a video teleconference to relieve some symptoms.
CLT evaluation must happen in person but lots of education can happen via video and phone. Instruction can be done to help patients learn how to do their own lymphatic massage….something is better than nothing.
Recovery from Lymphedema Surgery and Treatment
At PRMA, access to this surgery is now possible because measures were put in place. For DIEP flap surgery, it requires high powered microscopes to perform the anastomosis of the blood vessels. The lymphatic vessels are even smaller. The hospital PRMA uses purchased even stronger microscopes so the microsurgeon can properly view and repair these vessels for surgery.
Although the surgery is long, often five to six hours, the incisions are small and because of this do not require an overnight hospital stay. In fact, the patient leaves with a band aid over the incisions. Dr. Garza allows his patients to shower the next morning. He sees them about a week after surgery. No compression garments are worn the first month. He wants them to follow up with a certified lymphedema therapist six weeks following surgery.
Changes are seen in some patients almost immediately, but he reminds them it can take up to a few months for the lymphatic system to develop and mature after surgery.
Where are we Now?
Dr. Garza states that insurance coverage is improving. He believes when access to care becomes more widely available for patients and more surgeons perform and perfect the procedure, the landscape will change. Dr. Garza hopes insurance coverage will recognize lymphedema treatment and surgery procedures as the standard of care and offer coverage.
He continues with some more pearls of wisdom. I encourage you to download and listen to Episode 15: Lymphedema Treatment and Surgery here to find out more. We end with a quote from the infamous Ms. Kathy Bates, affected by lymphedema herself but also a strong patient advocate who educates on the topic.
I dare people not to pay attention.
Ms. Kathy Bates
Thanks for bringing attention to the face of lymphedema Dr. Garza. Enjoy the podcast!