Secondary lymphedema as a complication of surgical treatment for breast cancer: autotransplantation of lymph nodes using ICG lymphography

Secondary upper limb lymphedema remains one of the most significant complications of surgical and radiation treatment of breast cancer and is characterized by progressive impairment of lymphatic drainage, chronic inflammation, and soft tissue fibrosis. In cases of pronounced anatomical and functional damage to lymphatic collectors, the effectiveness of conservative therapy and lymphovenous anastomoses is limited, necessitating the use of physiological microsurgical reconstruction techniques. Vascularized lymph node transfer (VLNT) is considered a pathogenetically substantiated approach to restoring lymphatic drainage, combining the mechanical ≪lymphatic pump≫ effect with stimulation of lymphangiogenesis through growth factor secretion. Imaging modalities of the lymphatic system, including indocyanine green (ICG) lymphography and lymphoscintigraphy, play a crucial role in patient selection and in the assessment of surgical outcomes by enabling visualization of dermal backflow, collector obliteration, and the formation of new lymphatic pathways. The paper presents a clinical case of a patient with stage IIA lymphedema following comprehensive breast cancer treatment, in whom the absence of clinical improvement after lymphovenous bypass served as an indication for delayed breast reconstruction with a free DIEP flap combined with inguinal vascularized lymph node transfer. Postoperative follow-up demonstrated a reduction in limb volume, decreased dermal backflow, and the appearance of linear lymphatic flow patterns in the transplant area. These findings confirm the potential of vascularized lymph node transfer as a component of a comprehensive surgical strategy for the treatment of secondary lymphedema in patients after combined breast cancer therapy.

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