Center for Comprehensive Lymphatic Care

At AdventHealth, we have a surveillance program for cancer patients that will follow you closely after you’ve started your cancer treatment. We’ll measure your limb volumes over time and use bioimpedance to determine if you are developing an early form of lymphedema. If you do develop lymphedema, you’ll be referred to our lymphatic therapist, who will begin lymphedema physical therapy immediately. Our therapists are located on multiple campuses for your convenience.

Lymphatic physical therapy consists of performing complete decongestive therapy (CDT), which includes:

• Manual Lymphatic Drainage (MLD)

This technique empties and decompresses obstructed lymph vessels by rerouting the fluid into body segments where the lymph system functions properly. This therapy facilitates the unhindered flow of lymph fluid into the venous circulation, which allows the limb to return to normal or near normal size.

• Bandaging and Compression

Bandaging of the affected limb follows each manual lymph drainage session. This is important as it prevents the affected limb from refilling with stagnant lymph. An external compression is usually a custom-fitted compression garment that applies pressure on the skin and tissues to prevent the lymphatic fluid from reaccumulating.

• Remedial Exercises and Elevation

Corrective exercises with bandages in place are prescribed for every patient. This step activates the muscle groups and joints of the swollen limb. It results in increased lymph flow and further reduces limb swelling over time.

• Hygiene and Topical Skin Products

Meticulous hygienic care with or without antibiotics is essential. This treatment aims to eliminate bacterial and fungal growth, which can lead to repeated attacks of cellulitis and lymphangitis.

• Pneumatic Pumps

Manual lymph drainage is preferred to mechanical pneumatic pumping because it doesn’t damage remaining lymphatic vessels or their delicate valves.

This prophylactic operation is performed at the time of a mastectomy with lymph node removal or within 7 to 10 days of a mastectomy with lymph node removal. The goal of an ILR is to prevent lymphedema from occurring. In this surgery, the lymphatic channels or collectors draining the arm are identified in the armpit using a variety of special dyes. Once the nodes are removed, these channels normally scar down, leading to lymphatic flow blockage and possible lymphatic fluid accumulation, and lymphedema. Instead of allowing them to scar down, these collectors are sewn directly into an adjacent vein, allowing the lymph fluid to flow directly from the collectors into the vein, which significantly decreases the risk of developing lymphedema after an axillary lymph node dissection.

If you develop lymphedema and are controlling your symptoms with CDT, we can help improve your symptoms by performing a vascularized lymph node transfer. Your surgeon will remove four to six lymph nodes from another part of your body and transfer them to the affected area. The lymph node packet is attached to an artery and a vein to provide nutrition and oxygen to the “transplanted” nodes. Once your body heals, the lymph nodes will begin forming new lymph channels that will help drain the excess lymphatic fluid accumulated in the involved area. Using custom compression garments is still important, but you may not have to wear them as frequently throughout the day.

If you develop more advanced lymphedema, the tissues swell due to the accumulation of lymphatic fluid as well as from the accumulation of fat cells and scar tissue. This lipo fibrosis causes further enlargement. Your surgeon can help reduce the volume by removing the fat and scar layer with liposuction. This is often called lipo debulking, or suction-assisted protein lipectomy (SAPL). This operation is usually performed six months after the VLNT procedure if necessary.