David W. Chang, M.D., is professor in the Department of Surgery and the Chief of the Plastic and Reconstructive at The University of Chicago Medicine. He is currently President-Elect of the World Society for Reconstructive Microsurgery, and the past President of the American Society for Reconstructive Microsurgery. Dr. Chang specializes in complex microsurgical reconstructive surgery in cancer patients, and has a national and international reputation as an expert, an innovator and a pioneer in the field of surgical treatment of lymphedema and breast reconstruction. He has published more than 150 peer-reviewed research articles in high-impact journals as well as dozens of book chapters. He is also a prolific speaker, and has lectured at more than 200 national and international symposiums and meetings, while serving as visiting professor at institutions all over the world. Dr. Chang has been named to Best Doctors in America every year since 2001. He is on the editorial board of numerous leading medical journals including the Plastic and Reconstructive Surgery. He is a recipient of the Godina Traveling Fellowship from ASRM in 2005. Dr. Chang is a board examiner for American Society of Plastic Surgery since 2008.
My wife has severe breast lymphedema post lumpectomy/node removal. Her BMI is 48. Plastic surgeon recommends substantial breast reduction and said VLNT will not work. If we don't fix the core lymph problem, why won't the newly reconstructed breast simply fill up with lymph like her current breast?
1. Breast reduction maybe helpful but operating on tissue that has extensive lymphedema and is radiated can be difficult and could be prone to complications
2. Many studies have shown that VLNT can be helpful in this setting
3. BMI 48. I would recommend that she focus on reducing her BMI first before doing any surgery. There is no specific number but definitely below BMI of 40.
4. Lymphedema massage of the breast tissues
Considering venous transfer surgery but not covered by insurance. Cost is $20K. Want to know in general or on average how successful this procedure is in controlling lower limb swelling and how long on average benefit lasts. Lot to spend out of pocket so weighing cost against benefit important!
Venous transfer surgery? I perform lymph node transfer and lymphovenous bypass
My insurance carrier has a policy of not covering lymphedema surgery, stating that the literature does not support the efficacy of the procedure. Can you provide any literature to support that this is a medically appropriate procedure or provide clinical outcomes? Thank you
There are extensive publications that support the efficacy of these procedures. Sometimes it requires your surgeon to have peer to peer discussion with a medical director of the insurance provider and also provide them with the publications.
I am considering an omentum transfer if I am a candidate. I am not sure if the benefits involved with this surgery outweigh the risks. How common is this surgery for lymphodema and how risky is it?
I personally don’t do omentum transfer but there are many surgeons who do.
There are pros and cons to each approach. Make sure that you discuss pros and cons of all options with your surgeon before making the decision.
Hello Doctor, i am interested to have lymphovenous bypass surgery, but i came to know that most of cases develop swelling again after around one year, how can i know whether swelling will be back or not. Please advise why don't recommend complete decongestive therapy prior to lymphovenous bypass
All my patients do complete decongestive therapy prior to lymphovenous bypass surgery(LVB).
While LVB can be helpful, it is not a cure and patients need and should continue to manage their existing lymphedema with CDT, weight control etc, otherwise swelling can and will return. With care and compliance, many of my patients do experience long term benefit of LVB.
I just had a total hysterectomy in early November. The surgeon removed 17 lymph nodes which were all negative. I am currently getting 28 days of pelvic radiation. I am worried about getting lymphedema. Should i see a doctor knowledgeable about this in advance to help prevent getting it?
perhaps best to see a lymphedema therapist to get a jump start on exercises, garments etc.
Hello, I have suffered for over 10 years. I had compartment syndrome in both legs twice I have the surgery. Not one doctor here can tell me what is wrong.why my legs will swelled c/color hurt and After watching Dr. Phil I Thought could it be from the compartment syndrome?
If you suffered from compartment syndrome, you may have chronic damage to soft tissues and other structures in your leg. You should discuss with your primary care physician for further evaluation and studies.
I very got lymphdema in my hand and fingers since 2 months as a result of left breast cancer mastectomy, there were 20 nodes removed I started to face it just aftery radiation finished, l just read about the transplant surgery, is it possible and doable operation, can't stand my life with the lymphdema and I would risk anything to get cured. Please advice doctor.
Lymph node transfer is one of the surgical options that may help with lymphedema. I would advice that you visit with a surgeon who have experience in lymphatic surgery to evaluate your situation and discuss options.
I had bilateral mastectomy with immediate APEX/DIEP Flap reconstruction 6.5 years ago, I have always have a thickening, swelling pain in the armpit area. I thought (foolishly, I guess) that because I only had my sentinel node removed, and doctors bandaged the arm in which the sentinel node was to be removed from that I would be somehow immune from getting lymphedema. Well it has been getting worse. Now the entire armpit area, side of the breast, up and around the shoulder area, the bicep and now moving down to the hand, has a weird heaviness feeling, burning like pain, swelling but not in the arm that I can see, top of the breast area has a tight pulling feeling and the lower neck (right at the collarbone area) area at times feels like I have a tight necklace on, bad thing I don't wear a necklace. I go to a Physical Therapist on the 16th to do test to see if it is actually lymphedema. Is there anything I should be doing in the interim? I know you cannot diagnose without seeing it first but your best guess would be awesome. Thank you
Clinically, sounds like you have lymphedema.
You may consider lymphoscintigraphy to confirm.
in 2011 I had a bilateral mastectomy with immediate APEX/DIEP Flap reconstruction. I have always have a thickening, swelling pain in the armpit area. I thought (foolishly) that because I only had my sentinel node removed I would be somehow immune from getting lymphedema. Well it has been getting worst. Now the entire armpit area, side of the breast, up and around the shoulder area, the bicep and now moving down to the hand, has a weird heaviness feeling, burning like pain, swelling but not in the arm that I can see, top of the breast area has a tight pulling feeling and the lower neck area at times feels like my necklace is tight, bad thing I don't wear a necklace, I went to the breast specialist and was told they would refer me to a PT specialist but they didn't think it was lymphedema at all. Should I just not worry or should I pursue other avenues.
You can get lymphedema even after removal of just sentinel nodes.
Clinically it sounds like you have lymphedema.
You ca get lymphoscintigraphy to confirm but probably not necessary.
My 30 year old son has severe lymphedema in both legs and has been told he has no lymphatic channel in one leg. Would liposuction be sensible for him, and also what does node transplant entail ? Any help/advice would be greatly appreciated.
liposuction can be helpful especially if his lymphedema has significant fat component. Lymph node transfer involve transferring health lymph nodes from elsewhere in the body to the area of lymphedema. usually requires microsurgery.
I have had primary in right leg for near 50 years. About 3+ years ago after a nurse used unapproved later found out laser device several timesI started swelling right side and now into chest area also. Biopsy done right grown January 1973 and told it was chronic lymph disease. Over the years have had all treatment available including lymph air pressure machine, lymph drainage etc. Question: Can I be a candidate for lymph node transplant and what do I need to do to determine since there is limited information and no one doing that in AZ. Are their any trials (transplant) that I could participate in? I am 65 years old and more than basic knowledge of Milroy disease)Lymphedema praecox (Meige disease) Michael
Thank you for your question. you have a very long history of lymphedema.
It would be useful to get lymphoscintigraphy to assess your lymphatic function. Most hospitals with nuclear medicine department can do it.
Helpful to know your height and weight. any history of venous or vascular problems? Any other health issues, medications?
You could potentially be a candidate for lymph node transfer or lymphovenous bypass or both.