Bridging Lymphatic Flow Using Thoracodorsal Artery Perforator Flap for Breast Lymphedema: A Case Report

Abstract

　After undergoing breast cancer treatments, including radiotherapy, patients often experience breast lymphedema. Despite conservative treatments, failures can occur. Herein, we present a case of breast lymphedema successfully managed using a pedicled thoracodorsal artery perforator flap that included axial pattern lymphatic flow. Preoperatively, we performed ICG fluorescence lymphography to evaluate the lymph flow in the recipient region and to determine flap design. The subcutaneous scar of the lymph node dissection was released and the area of stagnant lymphatic flow from the breast to the axilla was bridged by a flap to reconstruct the lymphatic flow. The flap was positioned to facilitate antegrade induction of lymphatic flow to the subscapular region. Postoperatively, both breast edema and the contour of the axillary area were improved. To our knowledge, this is the first report detailing the surgical treatment of breast lymphedema using a flap that includes axial pattern lymphatic flow. Inducing lymphatic flow through a flap with axial lymphatic flow may be a useful approach for managing breast lymphedema.