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pipe. He could treat it in two different ways. One was a surgery called a lymphatic liposuction that reduces swelling. The other was a surgery called a lymph node transfer. In the latter, surgeons take lymph nodes from other parts of the body and use them to fix the spot where the lymphatic system is clogged, like a plumber replacing pipes. This allows the patient’s lymphatic system to drain fluid. While the procedure can’t completely reverse lymphedema, nearly 100% of patients saw a positive change, Schaverien explained. “I was stunned,” she says. “In nine years, Dr. Schaverien was the only person who had given me hope.” In December 2016, Mary had a partial mastectomy to remove the cancer, a sentinel node biopsy to determine if the cancer had spread and a lymphatic liposuction. Almost immediately after surgery, Mary noticed the swelling in her arm was gone. The biopsy showed some cancer still remained, so in May, Mary had a double mastectomy, reconstruction and the lymph node transfer. While the liposuction had already reduced the swelling, the lymph node transfer would help her lymphatic system drain normally, making the change more permanent. MD Anderson’s Breast and Plastic Surgery teams worked together seamlessly to perform all the procedures in one 10-hour surgery. “The collaboration between the teams was just amazing,” Mary says. Now, with more races under her belt, Mary shows no signs of stopping. She continues to run, swim and bike. “The surgery changed my world,” Mary says. “The quality of life I have now is just amazing.” A longer version of this story originally appeared on MD Anderson’s Cancerwise blog. 36 MD Anderson Cancer Center Revolutionizing breast reconstruction MD Anderson performs more breast reconstruction than any other reconstructive surgery. Almost all of our plastic surgeons perform breast reconstruction surgery, and they’re always looking at ways to improve the experience for our patients. Recently our plastic surgeons introduced a new way to perform breast reconstruction using biologic mesh. The original standard of care called for plastic surgeons to place the implant under the muscle, but thanks to a new technique called pre-pectoral breast reconstruction, doctors now place the implant over the muscle. This improves the aesthetic and reduces pain. MD Anderson was also the site of the novel use of a minimally invasive, robotic surgery that helps patients heal faster and more comfortably. To anchor a mastectomy patient’s implants, protect them from infection, and create a better cosmetic outcome, doctors cover the implants in one of two ways: with a biologic mesh, or with the latissimus dorsi muscle that is located in the mid and upper back. Jesse Selber, M.D., professor of Plastic Surgery, pioneered a surgery that helps patients heal faster after latissimus dorsi harvest by making three small incisions under the patient’s arm – each less than a half-inch in length - using the Da Vinici robot. This procedure is routinely performed only at MD Anderson. The success rate, Selber says, is 100 percent. “There’s been no loss of muscle viability,” he says, “and we’ve not had to convert to the more invasive technique.” Restoring quality of life Our plastic surgeons are dedicated to helping our patients return to the quality of life they experienced prior to their cancer diagnosis. One way they do this is by surgically treating lymphedema, a common cancer side effect that leads to severe swelling and occurs when the lymphatic system is unable to drain after the lymph nodes have been removed or damaged. Traditionally, lymphedema is treated with special massages and compression wraps. These treatments only help ease symptoms temporarily. But two different surgeries can be performed to actually reroute the lymphatic system and help fluid drain through the impacted areas, such as the arms. In one surgery called the lymphatic bypass, surgeons re-route the lymphatic system by disconnecting lymph vessels and reconnecting them to blood vessels to restore lymphatic draininage function. In another surgery called the a lymph node transplant, surgeons remove healthy lymph nodes from another part of the body – groin, abdomen, intestine, etc. – and move them to the area closer to the swelling so that the lymphatic system can drain properly. “Lymphedema has a huge impact on a patient’s lifestyle. It can be painful and can even make it difficult to find clothing that fits,” explains Ed Chang, M.D., associate professor of Plastic Surgery. “We’ve been performing these surgeries since 2008 and nearly 100% of our patients have experienced an improvement.” MD Anderson is the only institution that routinely performs both surgeries. Our plastic surgeons are researching how we can use these techniques not only to treat lymphedema, but to prevent it. “We currently have a trial for selected patients at high risk of developing lymphedema which involves prophylactic lymphovenus bypass surgery. We do the surgery at the time patients have the lymph nodes removed as part of their breast cancer treatment,” says Mark Schaverien, M.D., assistant professor of Plastic Surgery. “This is an ongoing study. Preliminary evidence suggests this is an effective strategy, and we hope to report more findings soon.” Using technology to improve outcomes Our plastic surgeons use
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