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BIDMC is one of the few hospitals in the world — and the only one in New England — to offer patients innovative bypass surgery to prevent lymphedema. We also offer lymph node transfer surgery for patients with chronic lymphedema.
Dhruv Singhal, MD, Director of Lymphatic Surgery at BIDMC, is a world leader in this field. Dr. Singhal collaborates with a multidisciplinary team of experts at BIDMC to offer you the best possible care. This team includes plastic surgeons, surgical oncologists, vascular surgeons, general surgeons, interventional radiologists, physical therapists, and professionals in nuclear medicine and body imaging.
Lymphedema is the build-up of lymph fluid under the skin, causing swelling, discomfort, and pain. The condition is usually not life-threatening, but it can affect quality of life. Your clothes and shoes may feel tight. It may be hard to walk or move.
In the United States, lymphedema most often occurs after lymph nodes and the vessels that connect them are removed during cancer surgery or damaged by radiation therapy. Lymph fluid accumulates in the area closest to the site of treatment.
While there is no cure for lymphedema, it is now possible to prevent the condition from developing in many patients at risk — and to treat it in those who have already developed chronic lymphedema.
Surgery to prevent lymphedema is known as lymphovenous bypass. Dr. Singhal reroutes damaged lymph channels so that lymphatic fluid is able to drain properly.
Dr. Singhal operates in conjunction with a cancer surgeon, so that you go to the OR only once. As the surgeon prepares to remove lymph nodes, Dr. Singhal injects a fluorescent dye into the limb closest to the site of surgery.
Using a specially designed microscope made for lymphatic surgery, with a filter that can visualize the glowing dye, Dr. Singhal locates the tiny lymph vessels and observes how fluid is flowing through them. If he detects any leaking vessels, he isolates the damaged channels and reroutes them into a vein nearby. After ensuring lymphatic flow is restored, Dr. Singhal steps aside and the cancer surgeon completes the original operation.
This surgery prevents lymphedema in many patients. Unfortunately, some patients may still develop lymphedema. For that reason, we closely monitor your recovery. If lymphedema develops, we want to intervene as early on as possible, when physical therapy and other treatments are most likely to be effective.
If you already have lymphedema, the first steps in treatment are:
A type of physical therapy known as manual lymphatic drainage
If these methods do not help, vascularized lymph node transfer may provide another option.
During this procedure, Dr. Singhal and his team remove healthy lymph nodes and vessels from another area of your body and implant them near the arm or leg affected by lymphedema. This helps to help improve the flow of the lymphatic fluid in the affected area as the body heals, with the goals of improving swelling and mobility.
It usually takes about a year for the transplanted lymph nodes and vessels to become fully functional. We will monitor your recovery closely.
At BIDMC, patients who are at increased risk of lymphedema are evaluated before they undergo cancer treatment. For example, a measurement before surgery is important to establish your “normal” level of lymph fluid, so that any increase after cancer treatment can be identified early.
As part of the pre-surgical process, your doctor will send an order for physical therapy through the online medical record system. Your appointment will be coordinated with your other pre-operative appointments.
At the first meeting, a physical therapist takes measurements of your fluid level, height, weight, limb size and limb movement. BIDMC has advanced technology that can detect even small increases in lymph fluid — even before swelling is visible.
After cancer treatment, follow-up visits at our Lymphedema Clinic are scheduled in three- to six-month intervals, depending on your risk for lymphedema. This ensures that we can detect any increase in lymph fluid levels, before symptoms develop. The earlier lymphedema is detected, the more effective are additional interventions, such as compression or massage.
If you already have lymphedema, we will take baseline measurements of your arm or leg during your first visit at the Lymphedema Clinic. Then we will develop a personalized treatment plan and schedule follow-up visits as needed to monitor your recovery.
We conduct clinical research to improve the care and outcomes for patients with lymphedema. Current studies include:
Acupuncture for breast cancer-related lymphedema: A pilot study; Osher Center for Integrative Medicine (PI: Dhruv Singhal, MD)
Development and validation of an MRI-based method to quantify fat and fluid volume to guide staging and treatment of lymphedema in the legs and arms; Radiological Society of North America (PI: Geunwon Kim, MD, PhD; Mentor: Leo Tsai, MD, PhD)
Development of a novel method to measure changes in real-time lymphatic flow after removal of lymph nodes in order to provide an objective measure of patient outcomes; Lymphatic Education and Research Network and the American Society for Reconstructive Microsurgery combined pilot grant (PI: Dhruv Singhal, MD)
Development of an Animal Model for the Surgical Prevention of Lymphedema; Plastic Surgery Foundation Grant (PI: Dhruv Singhal, MD)
Our 2017 Lymphedema Symposium was designed
to reinforce the importance of an integrated multi-disciplinary team approach
to lymphedema in order to bring about the greatest advances in patient care. Leading world authorities provided the audience with comprehensive advice about patient evaluation, therapy and
imaging, and both restorative and prophylactic surgery. In a Patient Symposium held immediately afterwards, patients spoke about their experiences with lymphedema treatment.