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J Reconstr Microsurg 2017; 33(08): 571-578
DOI: 10.1055/s-0037-1603738
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Contribution of Simultaneous Breast Reconstruction by Deep Inferior Epigastric Artery Perforator Flap to the Efficacy of Vascularized Lymph Node Transfer in Patients with Breast Cancer-Related Lymphedema

Shinsuke Akita
1   Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
,
Hideki Tokumoto
2   Division of Plastic and Reconstructive Surgery, Chiba Cancer Center, Chiba, Japan
,
Yoshihisa Yamaji
1   Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
,
Yoshitaro Sasahara
1   Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
,
Yoshitaka Kubota
1   Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
,
Maiko Kubo
1   Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
,
Motone Kuriyama
3   Department of Plastic and Reconstructive Surgery, Kochi Medical School Hospital, Nankoku, Japan
,
Nobuyuki Mitsukawa
1   Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
› Author Affiliations
Further Information

Publication History

04 January 2017

29 April 2017

Publication Date:
05 June 2017 (online)

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Abstract

Background The contribution of simultaneous breast reconstruction by deep inferior epigastric artery perforator (DIEP) flap to the efficacy of vascularized groin lymph node transfer (LNT) for breast cancer-related lymphedema (BCRL) was investigated.

Methods Patients were divided into two groups: the first group underwent groin LNT + DIEP flap surgery for simultaneous breast reconstruction (groin LNT + DIEP flap group) and the second group underwent groin LNT only (groin flap alone group). Patients with BCRL were evaluated based on indocyanine green lymphography findings. LNT was indicated only in advanced-stage BCRL cases, and groin nodes nourished by superficial circumflex iliac artery (SCIA) were used as donors. The side for the vascular pedicle(s) was decided based on our algorithm. In patients with pendulous breast, the flap was vertically transferred on the chest. Lymphatic function was assessed after LNT using imaging tests, and transferred lymph nodes were evaluated using ultrasonography.

Results In this study, 27 patients with advanced-stage BCRL underwent LNT. Of them, 13 belonged to the groin LNT + DIEP flap group and 14 belonged to the groin flap alone group. Although reduction volume was not significantly different between the groups, the number of patients in whom lymphatic function was improved and the need for compression therapy could be reduced was significantly higher in the groin LNT + DIEP flap group than in the groin flap alone group.

Conclusion When a patient with advanced-stage BCRL undergoes LNT based on SCIA, simultaneous breast reconstruction using DIEP flap may reduce the need for compression therapy.

Keywords

breast cancer-related lymphedema - breast reconstruction - lymph node transfer