Leave your lymph nodes alone! – If I were to come up with the best advice on prophylaxis of lymphedema that would be it.
When we have to deal with primary operable breast cancer with no lymph node lesions (or even if they were affected by pre-op radiotherapy) the the first thing to do is a biopsy of the sentinel lymph node. That will reduce the risk of post-op lymphedema by 84%!!!
Sometimes it’s impossible to do a biopsy, that’s when preventive lymphovenous anastomosis is performed.
There is vast experience gained in suturing the vessels with simultaneous lymph node removal. International research showed this kind of preventive treatment 3 times lowers the risk of lymphedema. The follow-up period is 1-2 years, because that’s the time when lymphedema is most likely to occur.
My own experience showed that in 4 out of 5 women after complex breast cancer treatment, there are some lesions in the lymph system – lymphedema was initiated. That condition with obscure swelling is an initial stage of the disease. 1 or 2 cm difference in arm circumference is no “insignificant swelling” but a full-scale lymphedema.
Preventive lymphovenous anastomoses can be sutured simultaneously with lymph node removal or as a delayed procedure.
In my practice, the latter is preferable due to the high risk of even perfectly sutured vessel damage by radiotherapy.
Simultaneous procedure (anastomosis and lymph node removal) also has its advantage – it significantly decreases the risk of lymphorrhoea (a collection of liquid in the armpit after treatment). Cut lymph vessels, that were damaged are sutured together with veins so the lymph drains and does not collect in tiss.