Table 1. Studies analyzing the use of LNT combined with breast reconstruction.
| Author | Demographic data | Follow up period | Population | Intervention | Average operation time | Circumference/symptomatic/volume reduction | Lymphoscintigraphy | Complications | Additional interventions |
|---|---|---|---|---|---|---|---|---|---|
| Saaristo (9), 2012 Finland | 9 patients; LNT/DIEP =4; LNT/ms-TRAM flap =5; mean age: 50 (range, 31–65) years | NS | Breast cancer with axillary lymphadenectomy and RT; symptoms 1 year before the reconstruction: 7 patients; few months before surgery: 2 patients | Microvascular free lower abdominal flap breast (DIEP or ms-TRAM) reconstruction + lymph node transfer (groin flap-LN flap)-LN-BR flap | 426 (range, 385–495) minutes | Reduction: 7 patients; no change: 2 patients; 0% of erysipelas infections | 3 and 6 months; improved flow: 5 patients (1 improve only distal flow); no effect: 1 patient | Seroma drainage of the axillary wound patients: 2; seroma drainage of the abdominal wound patient: 1; displayed delayed abdominal wound closure: 2 patients | Preoperative physiotherapy and compression garments 8 patients; postoperative physiotherapy and compression garments |
| Dancey (10), 2013 UK | 18 patients | Ranged from 4 to 22 months (mean of 14) | Lymphedema after breast cancer; NS the population characteristics | Chimeric vascularized groin lymph node flap + DIEP flap | NS | Quality of life measure for lymphedema (LYMQOL) besides the circumference: significant reduction in all domains, increase in quality of life score | NS | DIEP flap failure: 1 patient, after infection, causes by flap thrombosis; seromas at the groin area: 2 patients | NS |
| Chen (11), 2014 China | 10 patients; TRAM flap: 7 patients; DIEP flap: 3 patients; age: 36 to 50 years | 1, 3, 6, and 12 months | 6 patients accept radiotherapy; severe lymphedema: 4 patients; moderate lymphedema: 2 patients | Modified DIEP or TRAM + lymph node transfer (groin flap) | NS | No changes: 1 patient; reduction: 7 patients; 100% reduction: 1 patient; mean reduction was 2.122 to 2.331 cm | Before and 12 months after the operation; decreased stasis and improved lymphatic return | Breast reconstruction have delayed wound healing: 1 patient | Elastic bandages: for 1 year as an adjuvant therapy |
| Nguyen (12), 2015 USA | 29 patients; DIEP flap: 12 patients; TRAM flap: 17 patients; mean age of the patients was 52 (range, 31–69) years | Mean follow-up of 11 (range, 3–33) months | Axillary lymph node dissections: 93% patients; radiotherapy: 27 patients; average duration of lymphedema: 3.3 (range, 1–14) years | VLNT + (MBR) | NS | Symptomatic improvement: 23 patients (79%); mean differential volumes: 21% to 10% with 12 months | NS | Recipient (24%): delayed wound healing: 3 patients; partial mastectomy flap necrosis: 1 patient; venous thrombosis: 1 abdominal flap with successfully salvaged; donor (20%): groin seroma, garment-controlled, abdominal bulge | NS |
| De Brucker (13), 2016 Belgium | Total: 25; DIEP/LNT: 22 patients; average age was 49 (range, 33 to 70) years | Average time: 29 (range, 8 to 64) months | Axillary lymphadenectomy 100% patients; ISL: stage 1 or stage 2 BCR | Simultaneous vascularized lymph node; transfer and DIEP flap breast reconstruction | Unilateral: 365 (range, 255 to 540) minutes; bilateral: 515 (range, 475 to 555) minutes | Lymphedema-27 questionnaire score: mean of 44±18 to 26±16 (P<0.001); improved upper limb lymphedema-27 questionnaire scores: 21 patients (84%); no changes: 3 (12%); reported worsening: 1 patient (4%) | NS | Donor site: patients had a seroma: 3; patients had donor-site wound breakdowns: 4; Recipient site: lose the flap after infection: 1 patient | Preoperative compression therapy; postoperative physiotherapy and compression therapy |
| Montag (8), 2019 Brazil | Total: 24 patients; DIEP/LNT: 15 patients; mean age was 52.8 (38–68; SD =8.89) years | 24 months | Lymphedema: grade 1: 6 patients; grade 2:15 patients; grade 3: 5 patients; mean time between diagnosis and surgical treatment: 43.6 (range, 5–170; SD =47.61) months | DIEP-flap associated with the groin lymph node flap | NS | Mean volume loss: 20.1% (range: –66% to 90%; volume reduction: 20.6%; SD =44.89%); no cellulites episodes was reported at postoperative period | NS | NS | Complex decongestive therapy preoperative and postoperative |
VLNT, vascularized lymph node transfer; LN, lymph node; ms-TRAM, muscle-sparing transverse rectus abdominis musculocutaneous; DIEP, deep inferior epigastric perforators; MBR, microvascular breast reconstruction; BCR, breast cancer related; ISL, International Society of Lymphology.