Lymphedema Surgical Options in BC:  When Is Surgery an Option for Lymphedema?

Surgery does not cure lymphedema, but it may help reduce symptoms and improve your daily quality of life, if Complete Decongestive Treatment (CDT) has not provided enough improvement.

A lymphedema specialist may consider surgery when:

• Swelling is persistent or progressively worsening despite appropriate compression and lymphedema therapy. 

• There are recurrent episodes of cellulitis or other complications. 

• The condition is interfering substantially with movement, daily activities, comfort, or quality of life. 

• Imaging shows that functioning lymphatic vessels or suitable anatomy is present for a microsurgical procedure. 

In BC, the UBC/VGH Lymphedema Clinic doctors will provide a comprehensive assessment to provide the most accurate diagnosis and staging, to maximize conservative treatment and to determine if surgical treatment may be beneficial. Not everyone is a candidate. Surgery may be considered after 6 months of conservative lymphedema treatment without improvement. 

The UBC/VGH Lymphedema clinic provides the following types of surgeries to B.C. patients:

• Lymphovenous Anastomosis (LVA)  (Also known as Lymphovenous Bypass or LVB) is a minimally invasive microsurgical procedure that creates new pathways for lymphatic fluid to drain. During the procedure, tiny lymphatic vessels are carefully connected to nearby small veins. This allows excess lymphatic fluid to bypass damaged or blocked lymphatic vessels and drain into the venous system. By improving lymphatic drainage, LVA may help reduce swelling and other symptoms associated with lymphedema. LVA is generally considered one of the least invasive surgical treatments for lymphedema.

• Vascularized Lymph Node Transfer (VLNT) is a microsurgical procedure in which healthy lymph nodes, along with their blood supply, are transferred from an area of the body at low risk for developing lymphedema to a limb affected by symptomatic lymphedema. The goal is to help improve lymphatic drainage in the affected area.

• Liposuction or Suction-Assisted Protein Lipectomy (SAPL) is a surgical treatment used for more established lymphedema, when excess fatty tissue has developed in the affected area. The procedure is performed under general anesthesia to remove this excess tissue and reduce the size and weight of the affected limb.

Because lymphedema can involve delicate and impaired lymphatic vessels, this procedure should be performed by a surgeon with specialized training and experience in lymphedema surgery to minimize the risk of further damage to the lymphatic system.

Liposuction/SAPL does not cure lymphedema. Ongoing lymphedema management remains important after surgery and may include compression garments and other recommended treatments to help maintain the results and manage swelling.

• Prophylactic LVA, also known as LYMPHA (Lymphatic Microsurgical Preventive Healing Approach), is performed at the time of the original axillary lymph node dissection to reduce the risk of developing lymphedema. The procedure involves connecting a lymphatic vessel to a nearby vein to create a bypass that allows. lymphatic fluid to drain into the bloodstream, helping prevent fluid buildup.

• Here is a link to Patient Resources: What to expect from lymphedema surgery, by procedure type: Cancer Rehabilitation Canada 

To see if you are a candidate for surgery, start with your family doctor or nurse practitioner and specifically ask for a referral to a lymphedema specialist doctor, either Dr. Weiss or Dr. Kei. A referral to one of these specialists is recommended to get an appointment at the UBC/VGH lymphedema clinic to see plastic surgeons, Dr. Erin Brown or Dr. Kathryn Isaac.

If your primary care physician has diagnosed you with lymphedema, a lymphoscintigraphy scan is also required when you are referred to the Lymphedema Surgery Clinic.

• See Diagnosis for the list of these doctors in BC.