Areas of Expertise:
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.
After upper lobectomy and 19 lymph nodes removed I have pain and swelling. Massage and wraps started to help but not totally as now pain and swelling is limiting activity/walking. I am desperate for intervention and direction. Also affecting apetite and loosing weight. Any suggestions?
have you seen a physician to have this evaluated? is the swelling intrabdominal fluid or external soft tissue swelling? may need imaging for better evaluation.
Dear Prof. In stage ll primary lymphedema of one leg ,what is the best donor site for VLNT and when the patient feel improvement post op ? Thanks
It can vary from patient to patient. I personally prefer SCLNT but woudl also consider omentum as well. I would also consider simultaneous LVB as well if the patient has functioning lymphatic vessels.
VLNT can be placed in the groin, calf, ankle depending on the patient.
I inform patients that it would likely take 1-2 years before the effect of VLNT are noted…
I'm a PT, CLT. I work with a surgeon who treats GU cancers. Is it recommended that patients immediately get into LE/trunk compression after surgery? if so - what type? Or self monitor and at first sign of lymphedema, then get garments?
I am not aware that our GY surgeons are doing that…but would not hurt..certainly I agree that patients see you at fist sign…
Early intervention is important
Hi! I am researching LVA as a option for my primary lymphedema but understand that very few cases of primary lymphedema are suitable for LVA. How does a typical case that are suitable look like? Is it possible to conclude based on symptoms and/or results of lymphscintigraphy?
I use ICGN MAPPING for LV bypass…in many primary lymphedema, LVB is not possible but in some can be done…
How do I find a surgeon who I can consult re: LVA or other surgical options? I am in New Mexico. Any recommendations in nearby states? A consult at Mayo in AZ costs $5k out of pocket.. want to make sure it’s worth it. Thanks!
I don’t know anyone personally in New Mexico. Perhaps LERN can help identify someone as they have a list of providers.
Does bilateral removal and reconstruction with removal of back flab including tissue and muscle affect the right arm affected with lymphedema?
I think you are referring to LD flap…should not
I am a 40 year old woman who had servers trauma to my right leg when I was 8. I have had over 30 reconstructive surgeries. About 5 years ago I began to experience lymphedema issues in the lower part of the leg. Would I be a candidate for surgery?
I would suggest you be examined and evaluated by a surgeon with expertise in lymphedema for proper determination. Thank you
I have been diagnosed with lymphedema, left leg. I developed a four-inch wound around entire ankle now being treated by wound doctor to be followed by PT. I need to have hand surgery and oral surgery but am fearful of complicating consequences and would like your thoughts. Thank you.
if the wound is clean, I would check with the hand surgeon and oral surgeon if they feel comfortable going forward.
I had ovarian cancer in 2015.In 2016 I had a lymph node transplant in leg at Upenn. I wear a 30/40 compression stocking daily. Would an additional vein connection help with drainage. I have not had an infection since the transplant. There is roughly 2.5 cm difference in my legs.
you may benefit from lymph node transplant and LV bypass if possible.
I have breast cancer than spread to nodes. When I have surgery, I may need nodes dissected. Should I have lymphovenous bypass surgery at that time to prevent lymphodema or is it better to wait because I will be having radiation after. Does radiation damage the bypass? Thank you
if offered by your surgeons you should consider. Data seems to support efficacy even after radiation
Hello, My health insurance company recently denied my LVA/LVNT surgery. While they noted that both procedures showed a high degree of success, the studies had inhomogeneous groups; therefore, mudding the data. Are new trials/studies in the making to help support the case of patients needing these surgeries?
I am sorry to hear that.
There are several recent publications that support efficacy and many patients are able to get in covered. Sometimes appeal can work.
How do you become a candidate for lymphedema venous surgery. I had knee replacement revIsion. The knee had a tour quiet tied above it for 2 hours. 3 days later I had severe swelling. I have been pumping legs for 6 months, it is accumulating in my abdomen!!!!
Need work up to evaluate and diagnose that you have lymphedema.
swelling could be post-surgical, or venous related.
should start with lymphoscintigraphy.
Is there any kind of surgery that will fix this problem? And does drinking less fluids help with the swelling?
if you have diagnosed lymphedema, you may benefit from some or all of the following: lymph node transplant, lymphovenous bypass, liposuction or debulking.
It depends on number of variables: the extent of your lymphedema, type of lymphedema, your other medical conditions, your weight etc.
Drink water usually is not related.
What questions should I pose to general surgeon BEFORE surgery regarding the necessity of removing lymph? I had subcutaneous mastectomies in 1978. My family helped identify BRCA1 in human genome project. I have silicone implants now (third set). What are risks if I say no to removing lymph?
That is the question you should discuss with the breast surgeon regarding oncologic implication.
What my pt had done April 2018 lumpectomy in her R breast. May 26th 2022 double mastectomy tissue expanders and allograft (2 ALNs removed on the R and 1 ALN removed on the L) June 3rd, (L) breast necrosis June 23rd, removal of (L) tissue expander July 11th, bilateral breast reconstruction w/ diep flapswithrightcapsulectomy
sorry, what is the question?
2017 SLNB and swelling occurred in leg 5 months later (10% size difference). After CDT and daily compression wearing there is no ongoing swelling. Daily compression since onset in 2018. Recent MR Lymphangiography showed no sign of lymphedema. How to proceed? Could lymphedema be reversed? Do I continue wearing compression or only in high risk situations? Is there a small percentage for error on MR Lymphangiography?
in some patients, swelling following SLNB can be temporary.
I would work with your lymphedema therapist to ensure that you no longer need garment and therapy.
would take caution to avoid any infection to the arm which can reexacerbate lymphedema.
76 yo female with secondary lymphedema. Underwent LN transfer with abdominal debulking in 2016. Has since developed severe genital lymphedema with lymphorrhea and recurrent cellulitis. Need advice on surgery and location for MR lymphography. email@example.com
These are challenging cases. Perhaps LVB maybe considered. Not many places perform MRL….possibly MSK…
I got lymphedema after vascular surgery for leaking veins the doctor doesn’t seem to be concerned with the Lymphedema side affects however my legs swell so much and the pain is crippling can surgery help I have a Aerios 6 pump
Depends on the many factors:
1. the cause fo the swelling: may noit necessarily be lymphedema, could be due to vascular issues, other cariac or metabolic issues. you should have your physicians due work up including lymphoscintigraphy to assess your lymphatic function.
2. The extent of the swelling
3. your general medical condition including your body mass index
I have a lymphedema mass at the bottom of a pannus. Can it be removed before I weight qualify for pannus removal?
you shoud have this “lymphedema mass” evaluated by your surgeon prior to pannus resection.
Primary full body Lymphedema, my face showed worst on icg (dermal back flow at all injections), I have linear channels but very sluggish uptake almost everywhere and stardust on left shin. Will extremities LVA then possibly arms help my overall body LE including face? what are my options please?
I am sorry I don’t have any experience with patients with total body lymphedema.
I had phlebectomies on both legs about ten years ago, 110 veins removed from left leg and 80 from the right. A couple of years ago my left foot and calf started to swell and eventually the right swelled but not as much. I was diagnosed with lymphedema. Seem correct?
more likely venous problem. You may consider getting lymphoscintigraphy to assess lymphatic function. Often times venous and lymphatic issues can co-exist.
2013 lumpectomy/radiation DCIS. I do not have lymphedema in right arm(right leg due to nodes removed for melanoma mets) I am considering LVA to prevent. BUT if cancer did return in breast....would I still benefit of risk reduction for lymphedema?
Prophylatic LVB is done at the time of axillary node dissection. If you already had surgery at 2013 and if you don’t have lymphedema after 7-8 years, its unlikely you will get lymphedema in that arm. ..and I am not aware of any delayed prophylactic LVB.
Are there are surgical options for me? I'm suffering with head and neck lymphedema after tonsillectomy done years ago and possibly also have a venous insufficiency (toes turn purple when sitting)? Compression/manual drainage hasn't worked at all. Thanks.
It is rare that H&N lymphedema needs surgery as they are usually self limiting.
some have tried LVB with limited success. I personally have no experience with surgery for H&N lymphedema.
I’m 28 and I’ve had full leg Lymphedema over half my life. I had Ewing’s Sarcoma in my left hip and had radiation and surgery to treat. Am I too young for a surgeon to consider? I require daily compression to function, arthritis in hip makes MLD hard to do
no you are not.
You may send your info to:
if you wish further evaluation.
Can you provide research references supporting lymphatic surgery to improve lymphedema in UE and LE? If surgery doesn't "cure" lymphedema & compression is still needed, is it really that beneficial? (Like ablation for venous insufficiency; compression prevents wound development & is often needed after surgery, so why have surgery?)
my recent publication but there are many more studies that support that this significantly improves patients quality of life:
Outcomes for Physiologic Microsurgical Treatment of Secondary Lymphedema Involving the Extremity.
Beederman M, Garza RM, Agarwal S, Chang DW.
Ann Surg. 2020 Sep 1. doi: 10.1097/SLA.0000000000004457. Online ahead of print.PMID: 3288987
What is the success rate for lymphatic reconstructive surgeries like LVA and LVT for patients with secondary lymphedema when no cause of the lymphedema is found as of today. The patient developed first scrotal edema approx. 6 years ago. Approx. 4 years ago he developed leg edema without cancer.
He/she should be evaluated to determine the cause of “unknown” swelling.
Not all swelling is lymphedema.
If it is lymphedema but there is no known cause, then this would be considered primary lymphedema.
My sister is sufferi from extreme lymphrdema. The massages, compressions and pump doesn't seem to work. Fluid has built up in her arm back and chest. She has blockage and stage 4 breadt cancer the lymphefema is so painful its crippled her. Is there anything that can be done
it is possible. But she should be evaluated by a surgeon near her who has experience in this area to see if she is a good candidate.
Could you explain whether microsurgical repair from a lymphatic vessel ,close to the ankle, to a significant size vein could make much of a difference if it is the only lymphatics visualized in the ICG procedure prior to surgery on my leg? Thank you. Donna
Depending on how it was done. whether the bypass was patent, the technique that was used, amount of lymphatic flow from lymphatic into the vein, the extent of your lymphedema, There are many factors. Difficult to just say yes or no. But a single bypass can help in certain situations.
I had lymph node transplant 9/2019 ( Dr. Dayan), very successful down to 5% for 10 months. Tested positive for dormant cancer cells in bone marrow and became eligible for preventative CLEVER Trial. Started Everolimus 10mg 8 wks ago and just got lymphedema in that arm (15%)! Everolimus the problem?
Even after lymphedema surgery such as lymph node transplant and lymphovenous bypass, your lymphatic system is still not 100 % normal.
You are still at risk for flare ups for various reasons, such as mild infection that can lead to cellulitis, weight gain, etc…
You should check with your oncologist about Everolimus…its side effects
It took years to get a diagnosis for my leg lymphedema. I do not have confidence in my medical providers to help me navigate the management of the disease. Currently, I have lobes that are hanging on my inner thighs, which make it difficult to walk and sit, Please help
you may direct excision of “lobes” .
Can lymphatic bypass surgery be done on the upper arm?
yes but commonly done below elbow
Can lymphatic bypass surgery be done on the same arm more than once? Can lymphatic bypass surgery be done on the upper arm? Thank you for any information you can provide. Sincerely, jeff
Depends on how it was done the first time.
I usually do not offer it more than once to my patients as I do optimal number of bypasses at the initial surgery.
Just diagnosed with venous insufficiency - great saphenous vein both legs. Is venous ablation safe/recommended for Lipo/lymphedema? Concerned as I don't want to upset my already impaired lymphatic system. I work hard to maintain good control, day and night garments, pump etc Thanks!
Venous system and lymphatic system are actively intertwined.
You can get leg swellings from venous insufficiency. I would focus on treating the venous insufficiency.
Dear Dr. David If you allow me to ask 2 questions 1-Why we didn't use blue dye instead of NIRFLI in Dx of Lymphedema? 2-What are disadvantages of immediate LYMPHA techniq instead of post op. LVA? Regards
1. I use both isosulfan blue and ICGN during the surgery
2. LYMPHA is a relatively new technique that is done to theoretically reduce the chance for developing lymphedema. Once there is a strong evidence that LYMPHA can prevent lymphedema, I expect that this will become more common. We at University of Chicago do currently offer this to patients who will undergo axillary dissection. LVB is performed for patients who already have lymphedema.
I have lymphedema in my right leg & I'm considering a VLNT & a SAPL surgery. Which surgery do you usually perform first? I understand this is a matter for debate in the lymphatic surgery community.
I do microsurgery first and then debulking later if needed.
After u have been massage & wrapped and u have excess skin will getting surgery help.because both of my lower extremities from my thighs to my toes, now I have overlapping skin and it's putting a strain on my knees so can I have surgery or will lymphedema come back
Redundant excess skin likely will need excision.
19 year old daughter has had primary lymphedema since 2013. Lymphangiogram showed sever blockage at left groin and minor on right. Swelling is somewhat controlled with compression hose. Could she be a candidate for reconstructive microsurgery?
she could be yes.
I was diagnosed with stage 3 lymphedema 21/2 years ago and have been receiving treatment at the local lymphedema clinic for edema and wound clinic for a hand sized leaking wound on the back of my leg that has existed for a year now. Compression using JuxtaFit has helped reduce edema and flow of exudite from the wound, AquaCel AG Extra and ABD pads used underneath tube material to stabilize bandaging.
I'm considering lymph node surger of some sort and wondered what characteristics make a candidate for successful surgery?
1. the cause of lymphedema: secondary better than primary
2. no or minimal damage to venous system. may need evaluation by vascular surgeon
3. Extent of the fat deposition and tissue fibrosis: less the better
4. BMI< 35
5. general health condition
6. motivated and compliant patient
These are some but not all. Usually, difficult to accurately predict in advance.
How important is the Lund Node Cystic Node in the Calot Triangle)? Having Laparoscopic gallbladder surgery soon. I understand that this lymph gland is used as a 'landlord's in surgery to prevent Bile Duct Injury (BDI), and usually removes the lymph gland when removing gallbladder. I have primary lymphedema.
Hi I have just been diagnosed with lymphedema, I have a neurofibrome in the c6 part of the plexus brachial, operated on in 2013 but left in situ due to repurcussions if excised. I then had breast cancer, same side, had mastectomy, implant then explant and DIEP. 2017, 2018
I have now developed lymphedema on my upper right chest inbetween the plexus brachial op site and the mastectomised breast and on the right side of my back.
My question is this, is this normal and do you know of any other cases like mine as my health team here in France are confounded by the Lymphedema, it is causing breathlessness , fatigue etc and is becoming quite debilitating.
I only had the sentinel node and a couple others biopsied .
It is not uncommon to develop edema(“lymphedema”) in the area of back and Chestwall following mastectomy and especially after radiation.
If you had DIEP flap, that often helps. Main management would be massaging.
Daughter had lymph nodes removed left groin (cancer surgery 4 years ago) and suffers lymphedema in left leg. Could she be a candidate for either of these surgeries, and where in Oregon/Washington could we get consult with certified surgeon that has been doing them?
Try University of Washington in Seattle. Dr. Neligan
Is it possible if my mom find out that she has to remove her lymph node that I could donate some of mine to her
Had mastectomy in 2006 followed by radiation, mild lymphedema rt trunk below axilla and rt arm. mbc with mets to neck, brachial plexus and thoracic spine. planning to do palliative radiation to thoracic spine mets. considering hyperbaric oxygen to mitigate radiation side effects cannot get answers if this feasible. Pleaseadvise.Thankyou.
The role of Hyperbaric oxygen for lymphedema is unclear.
I would discuss with your oncologist whether Hyperbaric oxygen treatment is appropriate or safe oncologically.
I have lymphedema and consulted a vascular surgeon. After performing an ultrasound on both legs advised that I have vascular reflux and recommended radiofrequency ablation. Is this safe for lymphedema and if performed would my limbs swell excessively?
Leg can swell due to lymphedema or venous problem or both. Make sure you get full vascular work up and also lymphoscintigraphy for accurate diagnosis before planning any surgery.
I’ve had lymph node transplant and have seen noticeable improvement but I still swell. Can I still be a candidate for LVA?
if you have functioning lymphatic vessels left than they can be bypassed.
This can be assessed with ICGN lymphography.
Husband had hernia surgery. Lymph nodes were removed to chk for cancer. That was negative. Developed large Lymphedema at the groin site. Has a drain outputting 400ml daily for several weeks. Surgeon could not leak site with the dye. Could you locate origin of leak and LVA . Can you offer any suggestions.
sounds like he has lymphocele.
This can be managed in several ways. If the leak can be found that can be repaired. often difficult to find leak and this can managed by other means but doubt LVA would work.
If he is willing to come to Chicago, happy to evaluate him.
Had a total hysterectomy in July (including node biopsy) and have had very swollen feet and ankles ever since. Could I have lymphedema? Doc has not said much. Can’t seem to lose weight and am gaining.......
Yes, this can be lymphedema, but, of course, there are many other medical explanations that should be explored.
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 lymphedema of the right arm. My right hand needs extensive surgery for severe Dupeydren's. What should I do pre-surgery to protect my lymphedema? Should I wear kinesio tape or bandaging during the surgery? Should I be bandaged directly following the surgery? Thank you, Dr. Rockson. And thank you for all you do for patients with lymphedema.
Dr Dayan, I am a 52 year old male living with primary lymphedema on my right side. Complete right side from head to toe. I have been to many doctors over the years and have pretty much given up on treatment besides compression, massage, pumps etc. Recently I have been made aware of a more current surgery and wonder if this may be something that could help me. Any advice you may have would be great. Thank you. Howard
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.