Lymphatic Center Programs and Services

The Lymphatic Medicine Clinic has evaluated over 1000 new patients for lymphatic disorders since 2016. Brett Carroll, MD, cardiologist and Director of Vascular Medicine, and Betsy Rose, NP, lymphatic medicine nurse practitioner, thoroughly assess each patient to understand the cause of their symptoms. The focus of the clinic is to assure an accurate diagnosis and optimize management in close coordination with lymphatic therapy.

The Lymphatic Surgery Clinic evaluates patients for surgical interventions such as lymph node transplantation, lymphovenous bypass, and debulking procedures to treat lymphatic disorders. Moreover, the clinic evaluates patients for immediate lymphatic reconstruction to reduce the risk of developing lymphedema in high-risk patients, often cancer patients undergoing extensive lymph node removal.

Surgery to Prevent Lymphedema

Our Center has pioneered procedures for the surgical prevention of lymphedema. Surgery to prevent lymphedema is known as immediate lymphatic reconstruction. The most common scenario where this is offered is when a patient is diagnosed with a cancer that requires a removal of lymph nodes which is the greatest risk factor for developing lymphedema. Our lymphatic surgeons are present at the time of the lymph node removal to re-route damaged lymph channels so that lymphatic fluid can drain properly.

This surgery prevents lymphedema in many patients. Unfortunately, some patients may still develop lymphedema. For that reason, we closely monitor your recovery. 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.

Surgery to Treat Lymphedema

If you have been diagnosed with lymphedema, the first steps in treatment are:

• A type of physical therapy known as manual lymphatic drainage
• Compression garments
• Exercise

If these methods do not help, vascularized lymph node transfer or debulking may provide other options.

During a lymph node transplantation procedure, our team removes healthy lymph nodes and vessels from another area of your body and implants them into 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 to improve 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.

Another surgical option is a debulking procedure. During this procedure, our team removes excess fat accumulated in the arm or leg affected by lymphedema. The reduction in the size of the extremity is maintained long term with compression. The results from a debulking procedure are realized immediately.

The Lymphatic Therapy Clinic offers world-class care in the conservative management and diagnosis of lymphedema. The clinic is led by Kathy Shillue, Director of Outpatient Rehabilitation Services, who has dedicated the last 20 years of her career to the management of lymphedema. The inpatient team is led by Tegan Guilfoyle.

Surgical Follow-up and Physical Therapy

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.

The Lymphatic Imaging Group offers the full spectrum of diagnostic imaging including ultrasound, MRI, MR-Lymphangiography, Lymphoscintigraphy, SPECT-CT imaging, and Lymphangiography. The group also performs interventional procedures such as vascular and lymphatic stenting, embolization, and angioplasty. Physicians utilize sclerotherapy to treat vascular malformations and other vascular anomalies. Members of Lymphatic Imaging are actively engaged in lymphatic imaging research with funding support from the Radiologic Society of North America and NIH. The group is led by Leo Tsai, MD, Director of MRI at BIDMC.