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Lymphedema is a debilitating complication of breast cancer treatment and remains a therapeutic challenge. This study compared two vascularized lymph node transfer techniques: lymphDIEP and gastroepiploic transfer (GEVLNT).

A retrospective two-centre study was conducted on breast cancer-related lymphedema patients who underwent lymphDIEP or GEVLNT (2018–2024). LymphDIEP involved transferring the inguinal lymph nodes to the axilla via the thoracodorsal system during secondary autologous breast reconstruction. GEVLNT involved free omental lymph node transfer to the arm/forearm via gastroepiploic to radial/brachial anastomoses in previously reconstructed breasts. Data included demographics, surgical characteristics, lymphoscintigraphy, complications, limb circumference, non-surgical management, and LYMPH-Q outcomes.

A total of 37 patients (17 lymphDIEP; 20 GEVLNT) were included with comparable age, comorbidities and radiation. Although lymphDIEP patients had a higher BMI, GEVLNT patients had worse baseline limb circumference. Operative time was longer for lymphDIEP than for GEVLNT (423.6±57.0min vs 334.0±31.3min, p < 0.0001). Overall, complications occurred in 23.5% of lymphDIEPs (flap infection, partial DIEP flap necrosis, dehiscence) and in 5% of GEVLNTs (scar contracture). No flap failure was present. Preliminary postoperative data showed that both groups had improved lymphoscintigraphy Transport Index scores (-3.9±14.5 vs -6.0±6.1, p=0.679) with reductions in lymphatic drainage sessions and compression garment use. GEVLNT demonstrated faster reductions in limb circumference over time. At a significantly longer follow-up in lymphDIEP (38.0±15.3 vs 27.0±7.0 months, p=0.035), circumference reductions were greater at the arm and elbow, with comparable outcomes to GEVLNT at the forearm and hand. Postoperative LYMPH-Q Symptoms, Function, Appearance, Psychological and Arm Sleeve scores were improved in lymphDIEP.

Both lymphDIEP and GEVLNT techniques improved lymphedema outcomes. GEVLNT was associated with reduced operative time and complications, as well as faster circumference reduction. Although lymphDIEP demonstrated greater improvements in some outcomes, longer follow-up and better baseline values may have contributed to these differences. Additional follow-up data will help better assess comparative long-term effectiveness.

Microsurgical procedures such as vascularized lymph node transfer and lymphaticovenous anastomosis are nowadays increasingly used techniques in the treatment of lymphedema. However, comparative evidence regarding objective limb volume and circumference reduction remains heterogenous. This systematic review and meta-analysis compare objective volume and circumference reduction following LVA and VLNT in lymphedema surgery.

A systematic review and meta-analysis based on the PRISMA guidelines was conducted. PubMed, Embase and Ovid/ MEDLINE were searched from 2015 to March 2025 for studies reporting volume reduction and/ or circumference reduction after LVA and VLNT. Radom- effects models were used to pool mean percentage reductions. Prespecified subgroup analyses were performed by upper vs. lower extremity.

Overall, 29 studies were included. Pooled volume reduction was 27.42% after LVA (n=1006, 95% CI 21.84-33.00; I2= 98.4%) and 22.37% after VLNT (n=64; 95% CI 1.13-43.62; I2=96.7%). Pooled circumference reduction was 33.76% after VLNT (n=437; 95% CI 27.87-39.66; I2=98.1%) and 29.47% after LVA (n=243; 95% CI -0.27-59.21; I2=99.9%). Outcomes differed by limb location: LVA volume reduction was higher in lower- than upper extremity lymphedema and VLNT circumference reduction was greater in upper-extremity cohorts, although heterogeneity remained substantial (I2 96-100%).

Both VLNT and LVA are associated with clinically relevant objective limb reduction, but pooled outcomes show high heterogeneity and appear influenced by extremity location and cohort composition. Standardized outcome reporting and prospective comparative studies are needed to better define patient- and limb-specific procedure selection.

Massive localized lymphedema is a progressive condition characterized by large soft-tissue masses resulting from chronic lymphatic obstruction, most frequently affecting the medial thigh and groin. Surgical excision is often required, yet conventional elliptical resections are associated with high wound tension, dehiscence, and contour deformities. We describe a functional excision strategy combined with immediate reconstruction using a posterior thigh-based fasciocutaneous flap, termed the book-cover flap, designed to allow tension-free closure and improved contour restoration.

Eleven patients with medial thigh massive localized lymphedema unresponsive to conservative therapy underwent single-stage excision and reconstruction using the book-cover flap. Bilateral cases were treated sequentially. In selected extremities, liposuction-assisted debulking of fibrotic adipose tissue was performed. The anterior and medial borders of the mass were excised, while the posterior portion was planned as a thigh-based fasciocutaneous flap. Deep fascia and selected deep subcutaneous tissue were preserved to protect lymphatic and neurovascular structures. The flap was transposed in a book-cover fashion to achieve direct closure. Excised tissues were evaluated histopathologically.

All patients demonstrated improvement in functional mobility, hygiene, and quality of life. No flap necrosis, wound dehiscence, or major complications occurred. Contour restoration was satisfactory in all cases, with no relevant texture mismatch. During follow-up, no local recurrence or development of angiosarcoma was observed.

Functional excision combined with reconstruction using the book-cover flap represents a safe and effective surgical option for medial thigh massive localized lymphedema. The technique enables tension-free closure, durable soft tissue coverage, and improved contour outcomes compared with conventional excision methods.

Advanced breast cancer stages are associated with more extensive oncologic treatment, potentially increasing the risk and severity of secondary upper extremity lymphedema. This study aimed to investigate whether primary breast tumor stage correlates with baseline lymphedema severity and influences surgical treatment response following lymphaticovenous anastomosis (LVA) or vascularized lymph node transfer (VLNT), as well as postoperative complication rates.

This retrospective cohort study included patients with secondary upper extremity lymphedema treated between 2015 and 2025. All patients underwent lymphatic surgery, either LVA or VLNT. Tumor stage was classified according to the TNM classification at the time of primary oncologic diagnosis. Preoperative absolute limb circumference of the affected upper extremity was assessed as a measure of baseline lymphedema severity. Treatment response was evaluated at 24 months using relative excess reduction rate (RERR) and relative reduction rate of lymphedema (RRRR). Postoperative complications were graded according to the Clavien–Dindo classification.

A total of 59 patients with breast cancer-related lymphedema (median age 53.5 years, median BMI 25.9 kg/m²) were included. All patients underwent either LVA (37.3%) or VLNT (62.7%). Preoperative median absolute limb circumference did not significantly differ across tumor stages. At 24 months postoperatively, no statistically significant differences in reduction rates (RRR and RERR) were detected with respect to tumor stage. Complication rates were not significantly associated with tumor stage.

In this cohort, higher primary tumor stage was not significantly associated with increased preoperative limb circumference in patients with secondary upper extremity lymphedema. Furthermore, tumor stage did not significantly influence complication rates or early postoperative outcomes following LVA or VLNT.
These findings suggest that tumor stage alone may not be a reliable surrogate marker for lymphedema severity or surgical response.

This study aimed to evaluate the systemic effects of lipedema reduction surgery using lymph-sparing liposuction by assessing perioperative changes in hematological and biochemical parameters, including hemoglobin, sodium, potassium, creatinine, and C-reactive protein. Secondary objectives included investigating associations between laboratory changes and clinical variables such as lipedema stage, body mass index, patient age, and aspirated fat volume, as well as exploring the influence of comorbidities on surgical outcomes.

A retrospective observational cohort study was conducted at a specialized lipedema surgery center between October 2023 and March 2025. Sixty female patients with Stage I-III lipedema underwent 101 lymph-sparing liposuction procedures using power-assisted liposuction technique. Matched pre and postoperative laboratory values were analyzed to identify systemic physiological changes. Clinical records, surgical data, and standardized patient documentation were reviewed. Statistical comparisons and regression analyses were performed to evaluate relationships between biomarker changes and clinical factors.

Preoperative CRP levels indicated systemic inflammation in a substantial proportion of patients and showed positive correlations with BMI and lipedema stage, supporting the inflammatory nature of the disease. Postoperatively, hemoglobin levels decreased, particularly in advanced stages, but anemia remained subclinical and no transfusions were required. Hemoglobin reduction correlated moderately with surgical volume. Sodium, potassium, and creatinine levels remained stable, demonstrating preserved electrolyte balance and renal function. Regression analysis identified lipedema stage as the main predictor of hemoglobin change, whereas BMI, age, and surgical volume showed no significant independent effects.

Lymph-sparing liposuction appears to be a physiologically safe procedure with stable metabolic and renal profiles despite large volume fat removal. Hematological changes were predictable and clinically manageable. These findings support surgical treatment as a safe component of multidisciplinary lipedema management and provide objective laboratory evidence of its systemic tolerance.

Breast cancer-related lymphedema (BCRL) is a frequent and burdensome complication of oncologic treatment with substantial impact on physical, functional and psychosocial well-being. The LYMPH-Q Upper Extremity Module is a validated, lymphedema-specific patient-reported outcome measure (PROM) designed to evaluate lymphedema severity and quality of life among patients with arm lymphedema. To date, no translated and culturally adapted French version has been available.

We conducted a structured translation and cross-cultural adaptation of the LYMPH-Q Upper Extremity Module into French following the Q-Portfolio Translation and Cultural Adaptation Guidelines, in alignment with ISPOR and COSMIN recommendations. Translation process was conducted in the following steps: dual forward translation, reconciliation, dual back translation, expert and developed back translation review, and cognitive debriefing interviews with French-speaking patients. The translations were then adjusted based on patient feedback.

Five French-speaking women with unilateral BCRL participated in cognitive debriefing interviews. Overall, the French LYMPH-Q was well understood, with only minor issues reported for selected items and response options. Fourteen wording or phrasing difficulties were identified across the Symptoms, Function, Information, and Arm Sleeve scales. All issues were resolved through targeted linguistic refinements (e.g. clarification of symptom descriptors, standardization of response options, and context-specific terminology), without altering the underlying constructs of the original instrument.

The French version of the LYMPH-Q Upper Extremity Module questionnaire is a reliable and valid patient-reported outcome measure to assess the physical and psychological impact in French-speaking patients with upper extremity lymphedema.