‘Supermicrosurgery’ offers path to preventing lymphedema in breast cancer patients

This story first appeared in Healthy You - July 2025, The Gazette’s quarterly health publication.

Lymph nodes are an important part of a body’s immune system, acting as filters to fight infections as fluids move throughout the body. When these fluids rush to the site of an injury or infection, like a sprained ankle, a functioning lymphatic system helps reabsorb them into the body.

When breast cancer patients have surgery to remove their tumor, doctors will also biopsy an axillary lymph node, or a lymph node from their armpit. If the lymph node is found to be cancerous, doctors will perform an axillary node dissection, where all of the armpit’s lymph nodes are removed to prevent the cancer from spreading further into the body.

However, by removing these lymph nodes, the fluids that normally travel freely in the body can get backed up and cause painful swelling in the arm and hand, called lymphedema — a chronic, debilitating condition. Axillary lymph nodes are often the first location breast cancer spreads.

According to Physicians Clinic of Iowa plastic surgeon Dr. Vanessa Leonhard, the risk of lymphedema after an axillary node dissection is around 30 to 40 percent.

“Because there’s such a high rate of lymphedema in the upper extremity after an axillary node dissection, people started looking at different ways to prevent this instead of dealing with it down the road,” Leonhard said.

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Leonhard and Dr. David Jerkins of PCI are two of the only doctors in the state of Iowa who perform a supermicrosurgery called Lymphovascular anastomosis, or LVA. This surgery connects the lymphatic vessels in the arm to a vein from the chest wall, bypassing the armpit. This creates a new channel for lymphatic drainage from the breast and arm to flow through.

“We’re trying to keep that avenue open. It’s like a detour during construction,” Leonhard said.

They currently only perform the prophylactic — or preventative — version of this surgery, known as LYMPHA, or Lymphatic Microsurgical Preventative Healing Approach, usually for patients needing chemotherapy before surgery who already have known disease in their axillary lymph nodes.

This still relatively new surgery has been shown to reduce a breast cancer patient’s chances of getting lymphedema to around five percent.

LVA was developed in the past decade and is considered supermicrosurgery, involving specialized instruments and high-powered microscopes. Leonhard performs these surgeries at St. Luke’s.

Leonhard’s hope is that as more is known about LVA, insurance companies will start covering the procedure more so that they will be able to use LVA as a treatment for lymphedema patients as well.

“We’re trying to start with the easier side, which is the prophylactic side, just to try to prevent people from falling into the lymphedema category here in our community, and then we’re going to try and expand it further,” she said.

Risk factors

According to the National Institutes of Health, the greatest risk factor for breast cancer patients developing lymphedema is the number of lymph nodes removed. Other risk factors include radiation, chemotherapy and extreme obesity. In the United States, an estimated 10 million people are living with lymphedema.

Why it matters

It’s important to prevent lymphedema because once it starts, a patient can only manage it — not cure it.

Usually, this involves wearing uncomfortable compression garments for the rest of their lives. Cedar Rapids has lymphatic therapists who can help ease the symptoms. There are also lymphatic massage pumps that apply rhythmic pressure through cuffs to mimic the lymphatic system.

In severe cases where the lymphatic system doesn’t work anymore, fat deposition occurs from all of the built-up fluid. A type of liposuction is done to reduce the bulk and improve arm function, although this only provides temporary improvement.

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According to the Mayo Clinic, lymphedema caused by cancer treatment may not occur until months or years after treatment. While the condition can also be caused by traumatic injury, the biggest cause of lymphedema in the United States is breast cancer.

Signs of lymphedema include:

LVA surgery

Leonhard and Jerkins will talk to patients in advance of their cancer removal surgery about performing lymphovascular anastomosis during that surgery. While the procedure adds two to three hours to the surgery, it doesn’t change the recovery time afterward or add any additional restrictions.

Leonhard said that it is especially helpful to be part of the node dissection part of the surgery, because they can then advise the surgeon on which vessels to keep long.

LVA can not only improve patients’ quality of life: it also helps reduce the cost and time associated with treating lymphedema.

“You don’t necessarily need the lymph nodes, but you need a channel to get from the arm back to the body. So that’s what the goal of this is,” Leonhard said.