Simplified Lymphatic venous Anastomosis for the Prevention of Breast Cancer-Related Lymphedema: A Two-Patient Case Series

Breast cancer-related lymphedema (BCRL) remains a significant complication following breast cancer treatment, particularly after axillary lymph node dissection (ALND), which can disrupt upper-extremity lymphatic drainage and substantially impair patients' quality of life. Immediate lymphatic reconstruction, including the Simplified Lymphatic Microsurgical Preventing Healing Approach (S-LYMPHA), has emerged as a promising preventive strategy to reduce the risk of BCRL. This study aimed to describe the technical feasibility, operative characteristics, and early clinical outcomes of S-LYMPHA performed immediately following ALND in patients with locally advanced breast cancer. A descriptive case series was conducted involving two women with locally advanced breast cancer who underwent modified radical mastectomy with ALND, followed immediately by S-LYMPHA at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Clinical data, surgical procedures, additional operative time, postoperative complications, and early lymphedema-related outcomes were evaluated through medical record reviews and postoperative follow-up assessments. The procedure was successfully performed by intussuscepting multiple lymphatic vessels into a single branch of the thoracodorsal vein under surgical loupe magnification. The additional operative time required was 35 minutes for the first patient and 40 minutes for the second patient. During the three- and four-month follow-up periods, respectively, neither patient demonstrated clinical evidence of upper-extremity lymphedema, significant interlimb circumference differences, or subjective symptoms of arm heaviness. Postoperative complications included seroma formation and mastectomy skin-flap necrosis, both of which were managed appropriately. In conclusion, S-LYMPHA employing a multiple-lymphatic-vessel-to-single-vein anastomosis technique is technically feasible and may represent an accessible and effective preventive approach for reducing the risk of BCRL following ALND. Nevertheless, prospective studies involving larger patient cohorts, longer follow-up durations, and objective lymphatic function assessment methods are warranted to confirm its long-term safety and effectiveness.