Ask Dr. Erez Dayan

Area of expertise:
  • Lymph node transplant
  • Surgical treatment of lymphedema
  • Lymphaticovenous bypass
  • Liposuction for lymphedema
  • Diagnostic imaging of lymphedema
  • Lipedema
  • Lipolymphedema
  • New product development in lymphedema

Dr. Erez Dayan is a Plastic & Reconstructive surgeon practicing in Dallas, Texas. He completed his training at the Harvard Plastic Surgery program, where he became 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. Dr. Dayan was the prior Chair of the Scientific Committee of the Harvard Lymphedema Symposium and lead author of two books on Lymphedema and Lipedema respectively.


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  1. Question about liposuction for lymphedema leg
    Question (Regina, ):
    • Dear Dr. Dayan: I have lymphedema in my right leg since 2010 (after the uterine cancer surgery). Saw Dr. Stanley Rockson last week, and he said my lymphedema is stage II, and recommended to consider the liposuction procedure. Several questions: - are you performing this surgery? - how many liposuction surgeries for a leg have you performed ? - what are the results? Thank you for your time and help, Regina
    Answer:
    • Jul 2018

      Thank you for your question Regina. It is best to perform some baseline functional lymphatic imaging such as the indocyanine green lymphangiography to determine how much fluid vs fat content is in the extremity prior to considering liposuction versus lymph node transfer. I have performed many cases of liposuction. The success can depend on patient selection and expectations. One thing I will say is patients need to continue compression after liposuction (typically) indefinitely.

  2. Breast reduction?
    Question (Michelle, ):
    • I have mild Lymphedema throughout my entire body after abdominal surgical complications 8 years ago. I am medium built( 5’5 144 lbs) , wear pressure garments, use a pump and Self MLD. My breasts have always been on the larger size and now are 38DD or sometimes larger. My question is.... would a breast reduction cause my Lymphadema to get worse? For years I have wanted a reduction prior to getting Lymphadema and now my back is always sore with ridges at my bra straps. Do you have any experience with breast reductions and Lymphadema? I look forward to hearing from you and appreciate your thoughts. Thank you!
    Answer:
    • Jul 2018

      Thank you for your question. Breast reduction should not cause lymphedema to get worse, in fact it has a very high satisfaction rate and you sound like a good candidate for it based on our symptoms. I do not have experience with breast reduction and lymphedema per se.

  3. Kathy-breast lymphedema
    Question (kathy, ):
    • Hi Dr, Erez Dayan I had 2 lumpectomies in September and the sentinel nodes removed, they were non cancerous, after 3 more biopsies , I did the higher dose shorter version of radiation, tolerated everything very well. 2 weeks after radiation, I got sick with fever chills body aches night sweats and a sore chest and discovered my breast was all red and hot and swollen, turned out to be cellulitus and had a large abscess in my breast and staph infection. Spent 4 days in hospital on IV's and several months of different antibiotics, I still have an open wound, no more infection and my breast is still inflamed and much larger that my other one. I think I have lymphedema. Or is it a possibitity of inflammatory breast cancer. Getting quite tired of it all, my doctors tell me it will go away and to just be patient. I would like to see a therapist for help with the swelling. What are your thoughts?

    Answer:
    • Mar 2018

      As per Dr. Erez Dayan
      Thank you for your question and I’m sorry to hear about everything you are going through. It is difficult to say without a physical examination. Lymphedema of the breast has been described particularly after surgery/radiation. I would recommend seeing a lymphatic specialist who may be able to more accurately diagnose you. There are imaging modalities available (specifically indocyanine green lymphangiography) that have little/no risk and allow for a clear picture of the lymphatic drainage.

  4. LTU-904 laser for fibrosis in lymphedema
    Question (lili, ):
    • Hello Dr Erez Dayan and I wish you are well. I have lymphedema in my left leg. The edema is in toes up to ankles and not up to my knee. .Two toes and a little section on my leg are harder than the other sections and I think it is fibrosis . Is it safe to use laser ltu-904 for this sections? can laser cause more edema or damage in my leg? and what are other options to soft the fibrosis ?

    Answer:
    • Mar 2018

      As per Dr. Erez Dayan-


      Thank you for your question. I do not have any experience with laser for lymphedema. However, for fibrotic tissue associated with lymphedema liposuction is commonly used. The only caveat is that when performing liposuction in almost all cases you need to continue compression wrapping/CDT afterwards.

  5. Primary lymphedema
    Question (Pauline, ):
    • Hi Dr. Dayan. I am female, aged 65, healthy, slim and fit. I have primary lymphedema in my left leg and this was diagnosed when I was aged 22. Over the years, I have managed the condition very conscientiously with compression stockings. I used a compression pump for about 10 years when I was aged 40-50. My GPs over the years have been very uninformed about this condition so I have managed by myself with a goal to keep the swelling from getting worse. Recently, I have been reading about some of the new techniques to help with this condition ..... lymph node transfer, lymphovenous transfer ..... and I have decided to explore and undertake these treatments. Can you please let me know what my next steps should be. I have waited for all these years for a treatment that would help! Thank you very much for your time.

    Answer:
    • Dec 2017

      As per Dr. Erez Dayan

      Thank you for your question. The first thing to determine is what stage your lymphedema is and how much of the extremity is fluid versus soft tissue. This can be done via imaging such as indocyanine green lymphangiography which involves small injections between the webspaces of the toes and watching the ICG dye travel up the lymphatic channels. Once a clear stage is determined the surgical options include either lymph node transfer, LV bypass, or liposuction. The surgical options largely depend on what the imaging shows.

      Best wishes,
      Erez Dayan, MD

  6. which is worse: having blood pressure checked or an iv put on the side that has the lymph nodes remo
    Question (cathy, ):
    • Hello Dr. Dayan, I had a lumpectomy and 2 sentinel lymph nodes removed (right side). No problem with lymphedema on my right side. It has been 6 months and I am scheduled to have a procedure where they burn the nerves in my back (lumbar). I have had this done for many years, but my concern now is that when they do the procedure they will be checking my blood pressure a few times during procedure and will also have an iv to insert relaxation drug which I will have through the whole procedure also. I've read to avoid having my blood pressure checked, blood draws and iv's done on my right side to avoid the risks of lymphedema. They cannot do blood pressure or iv on my legs due to the nature of the procedure. I cannot see doing both the iv and blood pressure check on the same side, so I figure the iv on one arm and the blood pressure on the other arm. Which is more of a risk of possibly getting lymphedema? Should I do the iv on the side where my lymph nodes were removed (right) and the blood pressure on the left verses blood pressure on the (right/lymph nodes removed) and iv on the left? I appreciate your help. Thanks.

    Answer:
    • Jan 2018

      Thank you for your question. This is a very common issue (IV/BP) and lymphedema extremities. There have been no studies to my knowledge demonstrating strong correlation between issues after IV/BP on lymphedema extremity. In theory, if a patient had lymphedema and a needle was inserted in that extremity they may be more prone to infection. However, in the hospital setting clean/sterile technique is used and this is generally not an issue. I would personally proceed by avoiding puncture/BP monitoring on an affected extremity if possible (cant hurt to avoid) but would certainly not hesitate or stress over having to use the extremity for either IV or BP monitoring as needed. I hope this helps.

  7. Lymph edema carpal tunnel surgery breast reconstruction surgery post mastectomy
    Question (Bela, ):
    • 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.

    Answer:
    • Oct 2017

      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.

  8. Lymph edema surgery
    Question (Allison, ):
    • 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?

    Answer:
    • Oct 2017

      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.

  9. Vascularized Lymph Node Transfer
    Question (Rochelle, ):
    • 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 .

    Answer:
    • Oct 2017

      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.

  10. Finding a doctor in my area who will perform Lymphaticovenous bypass
    Question (Meghan, ):
    • 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.

    Answer:
    • Oct 2017

      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