March 1, 2024, was the first day of lymphedema awareness month. We hope you will share this information with the embedded podcast in your community for breast cancer patients affected by lymphedema providing them with the resources needed to treat this condition and let them know there are specialists in surgical treatment options as well. I am pleased to provide this summary of Episode 51: Lymphedema Treatment and Surgery for Breast Cancer Patients.
A Specialist in the Field of Lymphedema Treatment
My guest is Dr. Charles Anton Fries, Chief of Plastic Surgery and faculty surgeon at UT Health San Antonio and works as a microsurgeon with the team at PRMA, Plastic Reconstructive Microsurgical Associates, in San Antonio. The management of lymphedema has seen significant improvement in the past few years. We will educate, dispel some fears surrounding the possible occurrence of lymphedema, and bring you some resources for care.
The Function of the Lymphatic System
It is valuable for listeners to understand the function and importance of the lymphatic system. Dr. Fries begins by making an analogy of the blood flow in the arteries and veins flowing around the body pumped by the heart. Many of us are familiar with this. What we are less familiar with is the lymphatic circulation which Dr. Fried points out is a very high volume of four to seven liters of fluid a day. This fluid flows through lymphatic channels that are much smaller than arteries and veins.
Theses lymphatic channels pick up the fluid that seeps out from gaps between cells and arteries and veins in our bodies that otherwise would accumulate. This has to be returned to the main circulation system that is the job of the lymphatic channels. It differs from the circulation of the arteries and veins because there is no heart driving the lymphatic system. The lymphatic vessels have their own muscles in their vessel wall. Lymphatic channels move lymphatic fluid along. They have a system of valves just like the veins do. This intrinsic mechanism is damaged during breast surgery or from the effects of radiation.
Detection and Symptoms of Lymphedema
He points out that it is not fully understood in science why 30% of patients having surgery can get lymphedema and there is another 70% who do not. This 70% of patients can include those who have aggressive treatment like mastectomy, radiation, and axillar node dissection. When meeting a patient for the first time Dr. Fries goes over protocol not fully knowing what category patients will fall into and why he points out surveillance is so important.
Dr. Fries tells us some of the symptoms at the beginning are heaviness and swelling from the accumulation of fluid. This is the time to start intervening with treatments to prevent progression. Lymphedema is incurable and progressive. He shares with us that compression, massage, and pumps are affective in managing the progression of lymphedema and the burden of fluid that can accumulate. It can progress to skin changes. Patients with lymphedema are at risk of infections. Dr. Fries shares there is a very rare form of cancer born of lymphedema, angiosarcoma.
Finding Care for Lymphedema
Dr. Fries tells us lymphedema care is unfortunately variable around the country and care depends a great deal on a patient’s geography. He gets many of his patients from physiotherapists and cancer rehabilitation physicians. Treating lymphedema takes adjustments for patients fitting it around their lifestyles.
He points out the importance of patients taking a holistic approach to the management of lymphedema. This includes maintaining a healthy weight. One such study shows there is a real correlation between obesity and severity of lymphedema.
Surgical and Nonsurgical Treatment of Lymphedema for Breast Cancer Patients
We continue our discussion with surgical options both in the office and in the surgical theater. When the surgery is successful it can be life transformative for patients. This is the evolution of microsurgery that evolved to lymphatic procedures and the term super microsurgery was coined. It draws similarities to breast reconstruction microsurgery with the exception of using higher powered microscopes, instruments, and sutures to work on the smaller lymphatic vessels.
There are three brackets of surgery:
- Lymphatic bypass
- Vascularized lymph node transfer
- Excisional surgery and liposuction
The protocol for bypass surgery is to scan the patients in the clinic. They can watch firsthand while Dr. Fries tracks the flow and notices any blockage in the lymphatic system that may need to be corrected in surgery. Many patients gain a deeper understanding of what is going on within the tissue while watching this. This then determines treatment.
Finalizing our Discussion on Lymphedema Treatment and Surgery
Dr. Fries and I touch on issues with insurance coverage, and he proudly shares that one of his own patients was an advocate working for insurance coverage for the treatment of lymphedema. He still must do a great deal of appeals and peer to peer discussions to attain coverage for his patients. He expects coverage for insurance to improve as the benefits of the surgery get more widely published and treatment options established.
I would like to share a fine piece of advice and quote from Dr. Fries regarding lymphedema awareness.
Life is for living. Awareness, yes, but fear, no!
Dr. Anton Fries
Links we discussed in the podcast:
PRMA lymphedema measurement chart: https://prma-enhance.com/wp-content/uploads/2021/03/Lymphedema-Chart.pdf
YouTube video of the Podcast with Dr. Fries: https://youtu.be/PlY5lb14ovY?si=Jyr7v-p2RhYuDpSD
Enjoy the entirety of the podcast here: