An interesting article I received this morning from one of my very special gal pals, reprinted from the Post and Courier.com

Doubt seriously that my insurance would be amenable to it, but it's interesting none the less!

New surgical procedure offers treatment for lymphedema patients

By Jill Coley

The Post and Courier

Monday, November 17, 2008

The Post and Courier

Jane Dinnan wears a custom-made compression sleeve to help treat her lymphedema, swelling that came after the removal of 17 lymph nodes due to breast cancer.

Dr. Marga Massey operated on Dinnan last week, harvesting lymph nodes and attaching them to blood vessels in her armpit.

After Jane Dinnan won her battle against breast cancer, she faced the burden of lymphedema, or what she called her "lead arm."

Lymphedema is swelling that occurs in the arms and legs when the lymphatic system is blocked. Dinnan, 51, underwent a lumpectomy last fall, followed by radiation and chemotherapy to treat her breast cancer. Surgeons removed 17 lymph nodes from her right armpit in an attempt to halt the disease.

Without those lymph nodes to regulate the fluid in her arm, her limb began to swell. "It feels like firm Jell-O," she said, massaging her right arm.

The Mount Pleasant resident treats her arm with a custom-made sleeve and compression pump that looks like an oversized blood pressure cuff, pushing the built-up fluid out in waves.

"You never get rid of it. You have to continually maintain it," she said.

On Nov. 11, Dinnan underwent a procedure gaining popularity in the U.S. to alleviate lymphedema. Surgeons at Roper Hospital harvested lymph nodes from her groin and attached them to blood vessels in her armpit. Dinnan also underwent a mastectomy and reconstruction of her right breast with tissue taken from her stomach.

Dr. Corinne Becker, a French surgeon who is an expert in lymph node transfer, spent last week at Roper Hospital as a visiting professor.

Becker led a 2006 study on lymph node transplant that followed 24 female patients who suffered lymphedema for more than five years. The women's limbs returned to normal in 10 cases, decreased in 12 patients and remained unchanged in two, according to the study published in the Annals of Surgery.

"The procedure is no more common in France or Europe than here in the U.S. In fact, it is in its infancy stage around the world, with physicians and patients learning about it primarily through word of mouth," Becker said.

Becker joined a team of breast microsurgeons at Roper Hospital who perform the painstaking procedure that rebuilds breasts from patients' own tissue, attaching microscopic blood vessels to nourish the transplanted skin and fat.

Dr. Marga Massey, assisted by Dr. James Craigie, led Dinnan's eight-hour surgery. After attaching a blood vessel to a lymph node, Massey held a small microphone to the connection. The operating room cheered at the crackling sound of rushing blood.

"It's not an on or off switch, it's a shade gray," Massey said of the procedure. "Most have an improvement in quality of life but are not cured of lymphedema."

Improvement can usually be seen in three to six months, but the final outcome is not measured until two years, she said.

Massey, who is part of the Center for Microsurgical Breast Reconstruction, has offices in Charleston, Salt Lake City and Chicago and performs most of her surgeries at Roper Hospital.

Risks of the procedure include swelling in the extremity where the lymph nodes are harvested. "We're careful to only take three to five," she said.

Cost of the surgery varies widely, depending on other procedures carried out, as in Dinnan's case. Dinnan said that her insurance agreed to cover the procedure after she submitted letters of need from her doctors.

"I'm lucky," Dinnan said. "There are women who have been suffering with even bigger arms. Even if this helps a little bit, it will be worth it."

Lymphedema Q&A"

Q: What is the lymphatic system?

A: Lymphatic fluid is the clear liquid that bathes all the organs in the body and helps fight infection. Lymph nodes or glands regulate the lymphatic fluid. The nodes also collect cancer cells or bacteria floating through the body.

To detect infection, doctors often check areas of the body where lymph nodes are abundant — in the neck, armpits and groin — for swollen nodes.

Q: What is lymphedema?

A: Lymphedema is swelling that occurs, usually in the arms or legs. The swelling happens when the lymphatic system is blocked or lymph nodes were removed, and the lymphatic fluid accumulates.

There is no cure for lymphedema, but many treatments are designed to help, ranging from massage and compression garments to surgical transplantation of lymph nodes.

Q: How many people get lymphedema after breast cancer treatment?

A: Experts estimate a wide range, between 6 percent and 40 percent, of breast cancer patients develop lymphedema. The condition usually occurs within the first two years, but can develop up to 15 years later. Lymphedema also can occur congenitally or if a lymph node becomes blocked.

Q: What risks are associated with lymphedema?

A: In addition to the quality of life issues, people who suffer lymphedema are at higher risk for infection. In advanced cases, the tissue can harden creating a condition known as elephantiasis.