Dr. Erez Dayan is from the Harvard Plastic Surgery Program in Boston, Massachusetts. He has been actively involved in seminal research related to surgical treatments for lymphedema and new technology and imaging modalities for assessing fluid and fat content of various body parts. He has lectured and published on these topics on over 100 occasions nationally and internationally. He is the Chair of the Scientific Committee of the Harvard Lymphedema Symposium and lead author of two books on Lymphedema and Lipedema respectively.
I had been scheduled for carpal tunnel surgery immediately prior to discovery of breast cancer and mastectomy but that was then stopped. I have completed chemo and radiation therapy but the swelling in the arm pretty much post mastectomy has been ignored (breast surgeon not interested). As part of the chemo I suffered full body edema (all limbs) that has receded except for the arm on side of mastectomy. It has been six months and finally seeing lymphedema nurse now it is accepted that it is lymphedema but....... That has left me with questions. 1. Can the carpal tunnel surgery ever be performed (pretty much have no hand use) or will it make things worse (I am not sure how much worse things can get but I have been surprised more than once). 2. I understand without examination it is difficult but has 6 months delay in dealing with the lymphedema icompromised my chances of relieving it ? 3. Are various surgery procedures effective with high success rates or not (preying on the desperate) such as VLNT or SAPL or nano fibre scaffolds etc if it ever gets to humans etc ? I am sorry for such a long series of questions but all the surgeons I have met in my part of the world tell what they do and it is generally 1 thing and there are no options and no discussions and if I try to question them they get quite angry. I want breast reconstruction but funding cuts have them denying me for 2 years. II found a Canadian study that suggested breast reconstruction has relieved some people with lymph edema but more investigation needed. I am trying to stop myself from clutching at straws but I am having to use mr Google because I am getting no help and I am desperate physically and mentally. So I am trying to find out facts based on evidence and options based on latest knowledge rather than 15 year old knowledge because that is all they know and they are not up to date or aware. I can find no one here in New Zealand who says anything other than basically that I will just have to deal with it and live with it as it is. No one appears to be interested inlymphedema here other than nurses and therapists and sufferers. I need a plan that takes account of all factors related to my arm hand and breast and is holistic and thought through. Here the breast guy is interested in mastectomies and nothing else. The carpal tunnel guy knows hands and not breasts and there is no lymph edema person and they certainly never get together and come up with a plan. I've. Reconstruction and VLNT concurrently or reconstruction followed by carpal tunnel or everything together or ....... Right now it is nothing by anyone followed by don't call us and we will never call you back.
Thank you for your questions. I’m sorry for everything you are going through, I know it can be incredibly frustrating.
1) You can have carpal tunnel surgery (and should) especially if you have compromised hand function.
2) Lymphedema is a progressive disease and it can appear in a delayed fashion (even years later). Usually there is a delay in diagnosis, particularly after surgery because there is expected swelling from the operation (usually for a few months). I believe if you gain good control via conservative management (MLD, compression, decongestive therapy) it should help significantly. I do not believe that 6 months puts you in a significantly worse position as opposed to earlier identification.
3) The data on a variety of therapies is still being sorted out on a case by case basis. When selected carefully patients undergoing VLNTx or liposuction can benefit significantly but there are also those who do not improve as much as they hope for.
59 year old male with severe lymph edema in left thigh and calf creating limited mobility. Tried compression therapy several times with very limited success. Does surgery reduce the swelling in severe cases or is it something that will he will have to live with?
Thank you for your question.
There are a number of issues that would need to be clarified first.
(1) How long the lymphedema has been present
(2) What is the presumed cause (cancer operation/radiation/idiopathic)
Once these important pieces of information are known there are imaging modalities that can help assess what the fluid/fat content of the extremity is. As lymphedema becomes more progressive the extremity accumulates fibrotic tissue and fat instead of fluid. Compression therapy and manual lymphatic drainage are helpful for early stages in particular, and will not help with later stage lymphedema when the fat hypertrophy and fibrotic tissue is present. Also, it needs to be consistently done to notice benefits.
I would recommend seeing a lymphatic specialist to image the extremity either with indocyanine green lymphangiography or MRA. This will tell you the fluid/fat content of the extremity as well as current state of lymphatic function.
The two main surgical treatment options that would depend on your specific case and imaging findings can help with swelling in severe cases. Liposuction as well as functional lymph node transfers are the two options. Generally lymph node transfer is more successful in early stages and excisional procedures such as liposuction are performed for later stages.
I hope this is helpful.
I have had Lymphedema for several years. I am interested in having surgery. I have Medicare as my Primary Insurance. I called them and they need to have a ICD code to tell me if it is insured. I am going for an evaluation to find out if I am a canidat for the surgery. I asked them if this was covered by Medicare before I waste my time going to have all the testing and the cost of visit. Do you know who could tell me if this covered? I had a transflap reconstruction,2 years ago and they do not so this procedure .
Thank you for your question. Coverage largely depends on your location and surgeon. Unfortunately it is not covered all the time but under certain circumstances it can be. I would have your surgeons office attempt to gain approval from your insurance company.
I realize this may be a very simple question, but I have done google searches and I've come up with nothing. I have pretty moderate lymphedema, and I am interested in finding a doctor in my area wh will perform a lymphaticovenous bypass or liposuction for lymphedema. Do you have any resources, or can you point me in the right direction, as to where I should start looking? Thanks for your time and attention. I look forward to your reply.
Thank you for your question. Depends on where you are located. There are a number of excellent centers that focus on lymphatic surgery and treatment. Memorial Sloan Kettering is the one I know best, under direction of Dr. Joseph Dayan and Dr. Babak Mehrara