The lymphatic system is considered to be our “second circulatory system.” It has many important functions, including a key role in our immune system as well as maintaining fluid balance in our body. In the United States, the most common cause of lymphedema is breast cancer-related lymphedema. Breast cancer treatment often involves removal of some or all axillary (underarm) lymph nodes for staging and treatment purposes. Also, these same lymph nodes may undergo radiation therapy.
When an area in the lymphatic system is damaged by surgery or radiation, a progressive swelling may occur in the extremity. This swelling tends to worsen with time and can lead to severe soft tissue infections due to the protein-rich lymphatic fluid accumulation in the tissues. Many patients have a limited quality of life due to the size and weight of their extremity. In rare cases, lymphedema can progress to its own cancer called lymphangiosarcoma.
Dr. Erez Dayan of the Avance Plastic Surgery Institute in Reno/Tahoe, NV, has been at the forefront of lymphedema research and treatment advancement over the past 10 years. He has published key research articles on the surgical treatment of lymphedema and has been selected to serve on prestigious program committees such as the Scientific Chair of the Harvard Lymphedema Symposium, an international multidisciplinary consortium of lymphedema experts.
In select patients, Dr. Dayan can treat lymphedema through innovative techniques such as lymph node transfer, lymphatic venous bypass or liposuction. Dr. Dayan uses the most cutting-edge diagnostic tools, such as indocyanine green lymphangiography, for assessment and diagnosis. After your assessment, Dr. Dayan will discuss his recommended plan and will provide you with more information during your Reno consultation at Avance Plastic Surgery Institute.
- What is Lymphedema Surgery?
Although surgery for lymphedema is not a cure, in select patients it is known to help reduce the severity of the symptoms and mitigate complications arising from the condition, such as recurrent infections and the need for daily compression. With the use of cutting-edge microsurgery techniques, we are now able to address lymphedema in ways that were not previously possible.
Some options for surgery include:
Liposuction can be used to remove excess fat and scar tissue caused by lymphedema and lymphatic fluids that have spilled into the surrounding tissue, causing inflammation and fat cell growth.
- Lymphatic Venous Bypass (LVA):
This procedure helps direct fluid from the lymph nodes toward small veins. In select cases, this can be performed prophylactically at the time of breast cancer treatment and lymph node dissection.
LYMPHA stands for Lymphatic Microsurgical Preventing Healing Approach and is a preventive technique most commonly performed during breast cancer excision to reconnect lymphatic channels in an attempt to reduce chances for lymphedema.
- Vascularized Lymph Node Transfer:
Here, lymph nodes from other parts of the body are transplanted to make up for those damaged by cancer treatment. Typically, the healthy nodes are harvested from the abdomen, but they can also be harvested from the groin, neck, and chest area.
Non-surgical options include:
- Lymphatic Massage Therapy:
Here, lymphatic fluid is manually drained toward the nodes using a specific technique to promote lymphatic flow. The treatment is gentle and painless and can be performed several times a week. Lymphatic massage therapy is also used commonly by Dr. Dayan for patients after aesthetic surgery to improve swelling and promote lymphatic flow.
- What Are the Stages of Lymphedema?
- Stage 1:
- No signs or symptoms, but there is an abnormal flow in the lymphatic system. This stage can be seen in near-infrared imaging that Dr. Dayan performs called indocyanine green (ICG) lymphangiography.
- Stage 2:
- Fluid accumulates and the area swells up. Once the extremity is elevated, the swelling subsides. When you press on the affected area, it may leave an indentation.
- Stage 3:
- The swelling does not go away when the limb is elevated. Pressing on the affected area does not leave any indentation. The skin begins to thicken from underlying inflammation and scar tissue formation.
- Stage 4:
- Limb deformity is apparent (elephantiasis). The skin has thickened, and scarring and growths are now evident on the surface.
- How Can I Plan for My Reno Lymphatic Surgery?
The first step is to schedule a consultation with Dr. Dayan at the Avance Plastic Surgery Institute in Reno/Tahoe. During this consultation, he will assess your stage of lymphedema and discuss the best approach for treatment with you. Patients can expect to complete the following tasks before and during your consultation:
- Arrange for communication between Dr. Dayan and your lymphatic and occupational therapist
- Review a thorough medical and surgical history, listing any past or present conditions
- Provide a detailed list of any medications you’re taking, including supplements and herbs
- Undergo a physical evaluation
- Undergo near infrared indocyanine green lymphatic imaging for diagnostic purposes
- Discuss the risks and benefits of the procedure with Dr. Dayan
- Discuss the costs of surgery and insurance coverage options
- What Type of Anesthesia Will Be Used?
- Dr. Dayan will ensure you are kept comfortable throughout every stage of your procedure. General anesthesia is typically used, which means you will remain asleep throughout the procedure. Local anesthesia with sedation is another viable option in select cases. With either option, you will need a friend or family member to drive you home since you will not be able to safely operate a vehicle.
- Who Makes an Ideal Candidate for Lymphedema Treatment?
- Surgery is not a primary treatment option for lymphedema but has been shown to successfully improve lymphedema in select cases. The best candidate for lymphedema surgery is a patient who has been evaluated and optimized by a certified lymphatic therapist and is in less advanced stages of the condition.
- What Can I Expect from My Recovery?
- After your procedure, you will receive a detailed aftercare plan to ensure a safe recovery. It’s important to follow Dr. Dayan’s instructions to ensure your healing goes as optimally as possible. Dr. Dayan’s experienced nursing staff will regularly check on your progress in addition to scheduled visits with Dr. Dayan before and after your procedure.
- What Are the Fees for Lymphedema Surgery in Reno/Tahoe, Nevada?
- There are several different approaches to lymphatic surgery, and each will have a different cost. The best way to obtain an accurate quote is to visit with Dr. Dayan in Reno/Tahoe and undergo a consultation and physical evaluation. Our office can assist with filling out paperwork for insurance and with financing if needed.
- Why Choose Dr. Dayan at Avance Plastic Surgery Institute?
Dr. Dayan is a highly skilled plastic and reconstructive surgeon, with an extensive background in reconstructive surgery, face transplantation and complex microvascular reconstruction. He was trained at the Harvard Plastic Surgery Program, and later completed his fellowship at the world-renowned Dallas Plastic Surgery Institute.
Dr. Dayan has presented and published on plastic surgery topics on over 150 occasions, including the authorship of five books. He has published seminal articles on the treatment of lymphedema and has worked closely with pioneers in lymphatic surgery to describe techniques such as reverse lymphatic mapping and key anatomic considerations to optimize outcomes in lymphatic surgery.
Dr. Dayan is a regular speaker nationally and internationally, traveling to Europe, Asia, the Middle East and South America. He is the recipient of the Harvard Plastic Surgery Academic Achievement Award, the Robert Goldwyn/Harvard Medical School Grant and the Aesthetic Surgery Education and Research Foundation Grant. Dr. Dayan is also a key investigator and opinion leader for Allergan, Galderma, InMode and MTF Biologics.
Contact Avance Plastic Surgery Institute online today call us at (775) 800-4444 to schedule a consultation with Dr. Dayan.