Non-surgical treatments

• Complete decongestive therapy
• Manual lymph drainage
• Compression therapy
• Exercise
• Skin care
• Compression garments
• Advanced pneumatic compression therapy
• Laser therapy

Complete Decongestive Therapy

Complete decongestive therapy (CDT) is considered the gold standard treatment method in the treatment of lymphedema and includes two phases: reductive (phase 1) and maintenance (phase 2). CDT is a good option by reducing the volume of lymphedema and includes manual lymphatic drainage, compression therapy, and physical exercise, care of the skin such as self-management, followed by the port of compression garments.

Manual lymph drainage (MLD)

MLD is a hands-on technique and differs from standard massage by orienting the lymphedematous fluid to proper functioning lymphatics.

Compression Therapy

Compression therapy includes compression for efficient gradient with the tubular bandage on the affected limb. Short-stretch bandages provide low "pressure at rest" when the patient is at rest and 'pressure' that allows muscle contractions in the live interstitial fluid flow. These bandages also reduce fibrosis of the skin. Compression garments are different from compression bandages and are preferred in long-term treatment.

Exercise

The specific exercise is beneficial for patients with lymphedema. It is recommended that the compressive bandages or clothes must be worn during activity. Patients suffering from Lymphedema or those at risk for Lymphedema are encouraged to exercise.

Skin Care

 Low pH moisturizers are recommended to overcome skin cracking and drying to prevent entrance of microorganisms.

Compression Garments

Initial control of LE can be achieved with the use of compression bandages. Long term control is obtained with compression garments.

Laser Therapy

A number of randomized trials have reported that the therapy of low- level Laser (LLLT) improved measurable physical parameters, but also scores of subjective pain. LLLT increases lymphatic drainage by stimulating the formation of new lymphatic vessels, improving lymphatic mobility and preventing the formation of fibrous tissue.

Surgical treatments

• Direct excision
• Liposuction
• Physiological techniques
• Lymphatic-venous by-pass
• Lymph node transfer

Direct excision

These techniques include removal of tissues of lymphedema. This method, although does volume reduction, can be quite disfiguring. It can also require blood transfusions and lengthy wound healing. In extreme cases, these techniques allow for improvement in quality of life.

Liposuction

Using liposuction has been shown to be very effective at reducing the volume to near normal size of the effected extremity. This technique can be used in both congenital and acquired lymphedema. Liposuction technique provides long standing reduction in extremity size as compared to the normal side.

Physiological techniques

Lymphatic Venous Anastomosis (LVA) or Bypass

This technique contributes tomake connections between the lymphatic system and the venous system in the proximal or distal extremity. Deep and superficiallymphatics are anastomosed with nearby veins. Fluorescence is help to identify the lymphatic system and an operating microscope is help to assist in microsurgery.

Vascularized Lymph Node Transfer

There are different options for lymph node transfer, namely the location of the donor and the recipient sites. Options for lymph node harvest include the lateral thoracic region, groin, submental region, supraclavicular region and intraabdominal lymph nodes. Each donor site has its particular anatomic advantages and disadvantages, and contains varying number of lymph nodes ranging from 1–10. The lymph nodes can be harvested together with a portion of the skin if necessary. These operations require microsurgical skills to perform an arterial and venous anastomosis to provide blood supply to the transferred tissue. The results of lymph node transfer are quite promising and have been shown to provide both objective and subjective improvements.

Intraoperative Considerations

The nodal status defines one of the most important prognostic factors in breast cancer. However, although necessary, axillary dissection may compromise the lymphatic system thus contributing to the development of lymphedema.