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JAMA Network Insights
March 25, 2020

Surgical Treatment of Lymphedema

Author Affiliations
  • 1Division of Plastic Surgery, University of North Carolina, Chapel Hill, North Carolina
  • 2Division of Plastic Surgery, Stanford University, Palo Alto, California
  • 3Division of Plastic Surgery, Stanford University Medical Center, Palo Alto, California
JAMA Surg. Published online March 25, 2020. doi:10.1001/jamasurg.2020.0015

Lymphedema is a complex clinical condition characterized by the malfunction of the lymphatic system responsible for moving tissue fluid from the interstitium into the venous system of the body. This causes retention of tissue fluid in the soft tissues, with associated swelling, inflammation, and destruction of lymphatic channels and chronic pathologic soft-tissue changes.

Lymphedema may be caused by genetic or developmental abnormalities (primary lymphedema) or postnatal insults, such as nodal surgery, radiation, and infection (secondary lymphedema). Lymphedema affects 2 to 3 million people in the US alone. Secondary lymphedema affects 1 in 6 survivors of cancer.1 In the US, breast cancer–associated lymphedema is the most common cause of secondary lymphedema. The reported incidence of lymphedema after sentinel lymph node biopsy is 0% to 23%, while that for axillary lymph node dissection is 11% to 57%.2 Patients who undergo postoperative radiation are at increased risk.

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