What is your opinion on surgery for lymphedema?

Not effective: Lymphedema is best treated by prevention. Once lymphedema is present, treatment is compression. Surgery is not effective in most situations.

Not recommended: Cause unless its a lymphatic obstruction usually not recommended success rates low and very tedious.

Expertise needed: If true lymphedema, we have had excellent results with compression wrapping, mld and pumps with garments. Lymphedema is such a precarious situation that the surgery itself may exacerbate the condition. Though there are successes in the literature, I am more interested in the failures. If surgery fails, is the new version more complicated to treat than the original? Still too new for me to consider.

Lymphedema : I actually have performed successful surgery for lymphedema of the arm after mastectomy. Like with most procedures patient selection is paramount. In cases of post mastectomy lymphedema where the patient did not have a reconstruction i perform a diep flap reconstruction with a vascularized lymph node transfer combined with axillary scar release. Lymphatic bypasses are done after icg injection.