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.
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.