The effects in a prospective, single center study appeared durable through one year, although longer-term follow-up is needed, Dr. Chang reported here at the American Association of Plastic Surgeons meeting.

Compression garments, massage, and other conservative medical treatment remain the first line of defense for the 25% to 40% of breast cancer patients who develop lymphedema after chemotherapy or radiation therapy.

Although a wide variety of palliative surgical techniques have been pioneered in Europe and Asia, these options have been controversial and limited, Dr. Chang said.

At M.D. Anderson, he said, surgeons use lymphaticovenular bypass. This minimally-invasive technique involves two or three 1-inch or smaller incisions in the arm to insert microsurgical tools used to redirect lymphatic fluid to veins 0.3 to 0.8 mm in diameter.

"For the most part, lymphedema in the U.S. has not been treated surgically," Dr. Chang said. "The reason it hasn't gained popularity is that it's technically challenging and doesn't cure the lymphedema."

Given this skepticism, his group monitored outcomes of 20 consecutive patients who had lymphaticovenular bypass at their institution from December 2005 through September 2008.

All of the women had stage 2 or 3 lymphedema for a mean duration of 4.8 years before the surgery. Their breast cancer therapy had included axillary lymph node dissection in all cases, with preoperative radiation therapy as well in 16 cases.

Surgery lasted an average of 3.3 hours and patients were discharged within 24 hours afterward. The procedure included a mean of 3.5 lymphaticovenular bypasses per patient.

After surgery, patients resumed nonsurgical strategies, including compression garments.

Prospective follow-up over the next 18 months revealed significant postoperative clinical improvement in 19 of the 20 women.

Three patients reported clinical lymphedema reduction without a corresponding significant quantitative volume reduction.

The researchers found that, whereas before surgery, the affected arm was an average of 34% larger than the unaffected arm on quantitative volumetric analysis, the mean volume reduction afterward was:

• 29% at one month
• 33% at three months
• 39% at six months
• 25% at 12 months

Dr. Chang cautioned against over-interpreting the dip in the results at one year. Based on a series from researchers in Asia and Europe, limb volume plateaus at some point after surgery but yields durable results.

He also noted that arm volume didn't capture other qualitative benefits that may be more important for patient quality of life. "Patients feel the arm is softer and lighter than before."

The researchers reported no postoperative complications or lymphedema exacerbations.

"Lymphaticovenular bypass using a 'super-microsurgical' approach appears to be effective in improving the severity of lymphedema in patients with breast cancer," they concluded.

Dr. Chang said his team believes that these results will improve over time with continued fluid volume reductions. However, he acknowledged the small sample size and the need for long-term follow up.

The researchers reported no conflicts of interest.

Primary source: American Association of Plastic Surgeons Source reference: Chang DW, et al "Lymphaticovenular bypass for management of lymphedema in breast cancer patients: A prospective analysis" AAPS 2009.