title: An algorithmic approach to simultaneous vascularized lymph node transfer with microvascular breast reconstruction.
abstract: BACKGROUND
  Lymphedema is a common, progressive, and often debilitating condition that can occur after breast cancer treatment. Preliminary reports on vascularized lymph node transfer (VLNT) have been promising. We propose an algorithmic approach to simultaneous VLNT with microvascular breast reconstruction (MBR) and provide early results.
  
  
  METHODS
  All patients who underwent simultaneous VLNT with MBR were included. Postoperative evaluation was performed at standardized time points and included qualitative assessment and quantitative volumetric analysis.
  
  
  RESULTS
  Between 2011 and 2013, 29 consecutive patients with refractory lymphedema secondary to breast cancer treatment underwent simultaneous VLNT with MBR. Mean follow-up was 11 months. On average, patients had experienced 3.3 years of lymphedema symptoms with 21 % increased volume in the affected arm compared with the unaffected arm. Using our algorithmic approach, all patients underwent successful breast reconstruction. There were no flap losses, and no patients developed donor site lymphedema. Six patients (21 %) experienced donor site wound complications that resolved with conservative measures; 23 patients (79 %) reported sustained symptomatic improvement after reconstruction. The mean volume differential volumes improved to 20, 19, 14, and 10 % at 1, 3, 6, and 12 months after reconstruction, respectively.
  
  
  CONCLUSIONS
  Our algorithm provides a reliable approach to optimizing simultaneous abdominal free flap breast reconstruction and VLNT and demonstrates promising results. Long-term studies are warranted to further delineate and improve the safety and efficacy of lymph node transfers.
authors.affiliation: Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, atnguyen3@mdanderson.org.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Nguyen
authors.forename: Edward I
authors.initials: EI
authors.lastname: Chang
authors.forename: Hiroo
authors.initials: H
authors.lastname: Suami
authors.forename: David W
authors.initials: DW
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000098:blood supply / Q000150:complications* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000637:transplantation*; D042601:Lymphatic Vessels / Q000473:pathology*; D008209:Lymphedema / Q000209:etiology / Q000601:surgery; D016462:Mammaplasty; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D013524:Surgical Flaps / Q000098:blood supply*