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Breast Cancer Patient First for UAMS Lymphedema Surgery

June 4, 2014 | The University of Arkansas for Medical Sciences (UAMS) is the first in Arkansas and one of a handful of medical centers in the country offering a new surgical alternative to treat lymphedema, the chronic arm swelling frequently associated with breast cancer treatment.

The unique microvascular procedure at UAMS is performed by Mauricio Moreno, M.D., who learned the new surgery during his advanced training in microvascular reconstructive surgery prior to joining UAMS in 2009.

The surgery is the only permanent, effective treatment for lymphedema, which is caused by damaged lymph nodes that can no longer cycle excess fluid out of the arms and legs. In the United States the condition usually is a side effect of mastectomy or radiation therapy that compromises the lymphatic system. The result is swelling, numbness, discomfort and a high risk of infection.

Valerie Davis, of Smackover, the first lymphedema patient to have the surgery at UAMS, said the swelling from her mastectomy four years ago was disabling because it restricted the use of her left arm.

“The swelling was outrageous, even when I wore the compression sleeve,” Davis said. “It was really aggravating; I couldn’t lift things like I wanted to.”

Patients with lymphedema commonly see about a 20-40 percent reduction in swelling using massage and compression therapy, the traditional treatment for lymphedema. Such therapy involves extensive massaging to push the fluid from the extremities back to the torso. It is a temporary solution that has to be performed regularly because lymphedema does not improve over time – it only gets worse.

Davis said she tried the traditional treatments, which helped some but were a big inconvenience. When she heard about the new procedure, Davis said, she couldn’t pass up the chance it would bring relief.

“Dr. Moreno told me it had a 70 percent chance of working, so I took the 70 percent,” she said, adding that she’s happy she took those odds.

Davis saw an 81-percent reduction in her arm swelling within a month from the procedure.
“It was worth it,” she said. “I’m doing so much better now, and Dr. Moreno said the swelling would likely continue to go down.”

Lymphedema surgery involves connecting tiny lymphatic vessels to tiny blood vessels (less than 1 millimeter), giving the excess fluid a new pathway out of the arms or legs. The surgery was developed in Japan in 2003, and Moreno learned it from a surgeon who brought it to the United States from Japan.

Because the surgery is so new in the United States, its cost is not covered by insurance, Moreno said.

“I believe that over time, surgery will prove to be an excellent treatment alternative because it’s a permanent solution, low risk, and patients don’t have to maintain the frequent, very intensive physical therapies for the rest of their lives,” Moreno said.

He recently was awarded a $25,000 research grant that will go toward the surgical treatment of lymphedema.

The surgery is more challenging than routine microsurgery, he said. Traditional microsurgery involves vessels that range from 1 to 4 millimeters in diameter, while the vessels involved in lymphedema surgery are between 0.3 and 0.8 millimeters.

Moreno’s primary clinical duties at UAMS are as a head and neck cancer and reconstructive surgeon. His advanced training also includes surgical endocrinology and head and neck surgical oncology.

Moreno explained that in lymphedema’s early stages, the excess fluid remains liquid, but in its latter stages there is development of fibrous tissue, making any treatment much less effective.

The idea for offering the lymphedema surgery at UAMS came during a conversation between Moreno and breast oncologist Suzanne Klimberg, M.D.

Klimberg is internationally known for pioneering advances in breast cancer surgery that spares disruption to the lymph nodes.

UAMS is the state’s only comprehensive academic health center, with colleges of Medicine, Nursing, Pharmacy, Health Related Professions and Public Health; a graduate school; a hospital; a statewide network of regional centers; and seven institutes: the Winthrop P. Rockefeller Cancer Institute, the Jackson T. Stephens Spine & Neurosciences Institute, the Myeloma Institute for Research and Therapy, the Harvey & Bernice Jones Eye Institute, the Psychiatric Research Institute, the Donald W. Reynolds Institute on Aging and the Translational Research Institute.

Named best Little Rock metropolitan area hospital by U.S. News & World Report, it is the only adult Level 1 trauma center in the state. UAMS has more than 2,800 students and 775 medical residents. It is the state’s largest public employer with more than 10,000 employees, including about 1,000 physicians who provide medical care to patients at UAMS, Arkansas Children’s Hospital, the VA Medical Center and UAMS’ Area Health Education Centers throughout the state. Visit www.uams.edu or uamshealth.com.