Topic: LYMPHA (Lymphovenous Bypass) Procedure With Mastectomy?

Forum: Lymphedema — Talk with other about how to lower your risk of lymphedema and how to manage it if you've been diagnosed.

Posted on: May 12, 2021 05:41PM - edited Nov 21, 2021 07:55PM by lw422

Posted on: May 12, 2021 05:41PM - edited Nov 21, 2021 07:55PM by lw422

lw422 wrote:

Hello all. Today I had a meeting with my surgical oncologist to discuss my upcoming single mastectomy. I was kind of bummed to hear that that many nodes will be removed, and mentioned that I have a fear of lymphedema.

The SO said that a plastic surgeon will be called in to do the mastectomy close, and he also does a microsurgical procedure called a "LYMPHA." (Lymphatic Microsurgical Preventive Healing Approach). The procedure is also known as a lymphovenous bypass which attaches the cut lymphatic channels to tiny veins, allowing the lymphatic fluid to drain. She said this procedure will add about 3 hours to my surgery.

I told her that I am very interested in this procedure, particularly since it is done at the same time as the mastectomy and apparently is successful in reducing the chance of developing lymphedema. Has anyone here had this procedure in conjunction with their mastectomy, and how have you fared with this? Would you do it again? Any complications? Thanks for sharing. Log in to post a reply

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May 10, 2022 09:25PM minustwo wrote:

lw422 - thanks for your answer & for posting the thread. I to have only mild LE, but will be interested in reading.

How are you doing my Houston compatriot? I think of you.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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May 11, 2022 02:23AM worriedinhk wrote:

Hello everyone,

I'm new to this forum and desperately in search of information regarding Lymphovenous anastomosis (bypass) surgery and vascularised lymph node transfer surgery to treat lymphedema. My case is unusual in that (i) the lymphedema (Stage 2 now) occurred in my right arm BEFORE my breast cancer diagnosis (right breast, Stage IIIA, triple negative) and (ii) the lymphedema has not improved at all despite the breast and LN tumors shrinking significantly from my chemotherapy + immunotherapy regime.

My BS has now recommended the lymphovenous bypass surgery (as the first option) and lymph node transfer surgery (as the second option if no suitable channels are found to be able to perform the LVA bypass) to address the lymphedema but my insurance company is rejecting those "due to lack of acceptable current clinical evidence." The insurance company is saying that "to date, the evidence for lymphovenous anastomosis +/- vascularised lymph node for management of breast cancer-related upper extremity lymphedema is low."

Has anyone successfully gotten their insurance company to cover the LVA surgery? If so, would appreciate if you could share any tips and/or scientific literature support I can provide to the insurance company to appeal the denial.

Thank you in advance,

worriedinhk

Chemotherapy 11/27/2021 AC + T (Taxol) Immunotherapy 11/27/2021 Keytruda (pembrolizumab) Surgery 5/12/2022 Lymph node removal (Right): Underarm/Axillary; Mastectomy (Right): Simple
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May 11, 2022 07:19AM homemom wrote:

lw422 Thanks!

Dx 3/31/2014, IDC, 2cm, Stage IIB, Grade 1, 3/29 nodes, ER+/PR+, HER2- Surgery 4/15/2014 Lumpectomy; Lumpectomy (Left) Surgery 5/6/2014 Lymph node removal; Lymph node removal (Left): Underarm/Axillary; Mastectomy; Mastectomy (Left); Reconstruction (Left): Tissue Expander Chemotherapy 5/30/2014 AC Chemotherapy 7/25/2014 Taxol (paclitaxel) Radiation Therapy 10/16/2014 Hormonal Therapy 12/15/2014 Arimidex (anastrozole)
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May 11, 2022 08:06AM moderators wrote:

worriedinhk, we're sorry you have to be here for this, but wanted to send you a warm welcome!

We're sure some of our community members will offer some insight and advice shortly. Meanwhile, you may find some helpful information on surgical and non-surgical treatments for lymphedema on this page:

Treatments for Lymphedema

We hope this helps and we look forward to hearing more from you soon!

The Mods





To send a PM to the Mods: community.breastcancer.org/my/...
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May 11, 2022 12:09PM - edited May 11, 2022 12:11PM by lw422

worriedinhk--sorry you are suffering with insurance woes in addition to cancer and lymphedema. I had no problem with coverage (I'm in Texas and have Aetna + medicare and was treated at MD Anderson in Houston). Does the breast surgeon you're seeing perform the procedure or will you see a plastic surgeon for the microsurgery? It may be that the surgeon who actually performs the procedure has office staff who know exactly how to code the procedure to make sure it's covered. I know that others on the forum have had similar insurance problems and had to keep working the process to eventually get covered after initially being denied. Good luck.

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May 11, 2022 12:14PM lw422 wrote:

Hey -2! I'm doing OK, thanks. Looks like we're going to have a HOT summer in Houston. I'm not on here as much as I used to be, since the forum appears to be dying due to the inept IT "support." Hope you're doing well.

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May 11, 2022 04:12PM minustwo wrote:

lw422 - Agreed about BCO. I still try to log on every day or so - but again yesterday I couldn't log off. I'm only reading a few threads that are on my favorites for now.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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May 16, 2022 09:39AM worriedinhk wrote:

lw422 - I saw plastic surgeons for the microsurgery and had it last Thursday. They did the reverse mapping procedure and did not find any "good" / usable lymphatic channels so ended up performing the vascularized lymph node transfer instead of the LVA. I'm disappointed that they had to resort to the transfer instead of the bypass, but keeping my fingers crossed for any improvement. I've read it could take months to see any changes! Will continue to fight with insurance here to try to get it all covered...

Chemotherapy 11/27/2021 AC + T (Taxol) Immunotherapy 11/27/2021 Keytruda (pembrolizumab) Surgery 5/12/2022 Lymph node removal (Right): Underarm/Axillary; Mastectomy (Right): Simple
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May 16, 2022 09:44PM lw422 wrote:

worriedinhk--Thanks for the update. I hope you're doing OK and I really hope the node transfer is a huge success for you. I think all of these procedures are "iffy;" they just don't seem to have a good, proven fix for LE. It's sad that we have to add insult to injury after battling cancer, but it is what it is. Please let me know how you progress. My very best to you for a successful outcome. Take care.

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May 26, 2022 12:30PM lw422 wrote:

Thought I'd update with a little progress report. It has now been 9 months since my LVA bypass and mastectomy, and so far, so good. I occasionally have a little stiffness in my fingers but that happens on both sides so I "assume" it's arthritis. I have pretty much stopped the lymphatic self-massage since it never seemed to affect anything, but at least I learned how to do it in case I ever need to. At my checkup last week my arms were measured and there is still no noticeable change; my right arm is slightly larger but it is my dominant arm and has always been slightly larger.

So even though it's really impossible to determine whether the LVA was a success, I'm happy that for whatever reason I have managed to avoid LE so far. I'm living my life normally (as advised by my doctor)... gardening, taking hot baths, not babying the arm at all.

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