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Patient Advises, 'Run, Don't Walk'

Conquest - Summer 2009

New Surgical Procedure Alleviates Lymphedema

By Laura Sussman

Susan Buck at the Houston
Museum of Natural Science

At heart, Susan Buck is an educator.

An English teacher and librarian for nearly 30 years, she left the classroom five years ago to lead Houston Museum of Natural Science's field trip efforts. In the beginning a department of one she now heads a team of 11 who develop curriculum and arrange class visits from schools in the more than 50 school districts in the Houston area. Under her tutelage, more than 400,000 students visited the acclaimed museum in 2008.

Buck also became the learner when she was diagnosed with stage II breast cancer in July 2005. After undergoing a second surgery because of lymph node involvement, she experienced a painful and all-too-common side effect of her surgery, lymphedema.

According to the National Cancer Institute, 25% to 30% of women who have breast cancer surgery with lymph node removal and radiation therapy develop lymphedema. The condition results when lymph nodes are removed or blocked due to treatment and lymph fluid accumulates, causing chronic swelling in the upper arm. Currently, there’s no cure or preventive measure, and it’s difficult to manage. Compression bandages, massage and other forms of therapy are commonly recommended options for patients.

Lymphedema compromises quality of life

“I had total confidence that I would survive my cancer, but the lymphedema was another story. Despite wearing compression bandages and doing physical therapy, I just couldn’t find relief — my right arm was 17% larger than my left. At some point, I felt like my fingers were going to explode,” Buck remembers.

When months of physical therapy didn’t relieve her symptoms, Buck turned to David Chang, M.D., professor in M. D. Anderson’s Department of Plastic Surgery and director of the Plastic Surgery Center. Chang is one of only a few physicians in the country to offer a technically complex, super-microsurgical technique known as lymphaticovenular bypass.

“Lymphedema is like a massive traffic jam with no exit,” Chang says. “This procedure helps relieve the condition by giving the fluid a way out. Until now, surgical techniques, in particular, have been limited, making it important to determine which new techniques promise to bring real benefits to patients.”

In the surgery, Chang uses tiny microsurgical tools and makes two to three small incisions measuring an inch or less in the patient’s arm. He then redirects lymphatic fluid to microscopic vessels — approximately .3 to .8 millimeters in diameter — promoting drainage. The minimally invasive procedure is usually completed in less than four hours under general anesthesia, allowing patients to return home within 24 hours.

Surgery makes a difference

Researchers evaluated 20 M. D. Anderson breast cancer patients with stage II and III treatment-related lymphedema who underwent the bypass from December 2005 to September 2008. Prior to surgery, the patients’ affected arm averaged 34% larger than the unaffected arm.

Of the women, 19 reported initial significant clinical improvement. In patients with postoperative analysis measurements, the average volume reduction was:

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

Long-term follow-up with patients is necessary to determine if drainage continues after one year. Chang believes that fluid volume will keep decreasing over time. He also notes that while the surgery is most effective when completed in earlier stages before the affected arm is fibrotic, almost any breast cancer patient with the condition is a candidate.

“Working toward a definitive technique to cure this encumbering side effect and improve a patient’s quality of life is our priority,” he says. “As we begin to refine our technique, we have the potential to impact a large number of people. In the future, the surgery could possibly be used as a preventive measure for lymphedema.”

Two years post-surgery, Buck couldn’t be happier with her results. Her right arm is now just 7% larger than her left, in the normal range. Even more, the decreased swelling allows her the freedom and range of motion she had before breast cancer.

And when it comes to sharing word of the surgery, Buck admits to doing a little more than educating.

“I approach total strangers I see wearing compression bandages,” she says. “I tell them to run, not walk, to Dr. Chang. It may not work as well on them as it did on me, but how will they know if they don’t take the chance?”

© 2015 The University of Texas MD Anderson Cancer Center