Reducing Lymphedema Risk Through Preventive Surgery

When Emmie Cheses, 46, of Bexley, Ohio, learned her breast cancer treatment would involve the removal of numerous lymph nodes on her right side, she was concerned about the realistic possibility of developing lymphedema.

An estimated 3 to 5 million Americans — and a staggering 140 to 200 million people worldwide — will experience chronic lymphedema, uncomfortable and oftentimes mobility limiting swelling of the arms, legs, hands or feet that occurs as a side effect of cancer treatment. Breast cancer patients treated with a combination of surgery, chemotherapy and radiation are at the highest risk, but lymphedema can occur in all forms of cancer that require full lymph node dissection.

An active mother, Cheses was concerned about future lymphedema impacting the use of her dominant arm, as she is right-handed and her cancer was on her right side. A friend told her about Roman Skoracki, MD, chief of oncologic reconstruction at The OSUCCC – James, and the lymphedema-relieving surgery techniques he helped pioneer and was now offering in Columbus, Ohio.

“I knew I was at a high risk of getting lymphedema. I was really concerned about my future,” says Cheses. “When Dr. Skoracki told me this surgery could reduce my chances of developing lymphedema from 40 percent to less than 4 percent, there was no question: I had to do everything I could to reduce my risk of developing the lymphedema.” 

Cheses had a preventive lymphovenous bypass with Skoracki, a so called “supermicrosurgery” procedure that involves using tiny shunts to re-direct the flow of lymph fluids around the affected area. This creates pathways for the fluid to flow freely, avoiding the “traffic jam” that can cause lymphedema swelling.

The bypass procedure has traditionally been done to reduce/manage existing lymphedema. In Cheses’ case, the procedure was done with the hopes of preventing the condition from developing at all. The surgery was performed at the same time as her lymph node dissection, allowing her surgeons to complete two procedures through one incision site.

Understanding Lymphedema

Skoracki says lymphedema is a significant clinical issue that has serious quality-of-life implications for cancers survivors. The severity and persistence of the condition varies based on each patient’s specific situation.

“Up to 40 percent of all cancer patients who have full lymph node removal will develop lymphedema. This is also true specifically for breast cancer,” says Skoracki. “Now we can offer patients a surgical approach to better manage their lymphedema and – in some cases – prevent it from occurring entirely.”

It’s too early to know if the lymphovenous bypass procedure will prevent Cheses from developing lymphedema, but she is optimistic and wants other women to know they have options.

“I had no idea this type of surgery was available before facing my own diagnosis and began researching my options,” adds Cheses. “All cancer survivors at higher risk for lymphedema should know they can advocate for themselves and take steps to ensure quality of life after cancer.”