Lymphaticovenous anastomosis: Treatment of a persistent breast seroma

Abstract

Lymphaticovenous anastomoses are mainly used in secondary limbs lymphedema. They also can be used to treat iatrogenic seroma. This technique was used to treat a patient with a painful breast seroma that appeared after a mastectomy with axillary dissection, resistant to multiple ponctions and persistent 8 months after. Pre operative both lymphoscintigraphy and lympho-MRI have been performed and we identified lymphatic ducts responsible for the seroma. The one involved in the seroma was also the preferential drainage network of the arm. Innoperative, we performed an indocyanine green angiography to map those lymphatic ducts. A total capsulectomy of the breast seroma has been performed. An incision was made in front of lymphatics selected for lymphaticovenous anastomoses on the anterior axilla face. We performed two microscopic lymphaticovenous anastomoses. The patient was followed up at one, three, six months and one year post operative. No recurrence occurred during the follow-up. At six month the arm perimeter reduced of two centimeters. Lymphoscintigraphy and lympho-MRI were performed at six month showing a disappearance of the drainage asymmetry and collateralities of the upper limb; and no measurable volume in projection of the right breast area. Lymphaticovenous anastomoses may be an effective therapeutic solution for resistant seroma after node dissection. Lymphoscintigraphy and lympho IRM are very useful in those cases.

Keywords: Anastomose lymphatico-veineuse; Angiographie au vert d’indocyanine; Axilary lymph node dissection; Breast radical surgery; Breast seroma; Curage axillaire; Ganglion sentinelle; Indocyanine green; Indocyanine green angiography; Lymphaticovenous anastomosis; Lymphocèle mammaire; Lymphoscintigraphie; Lymphoscintigraphy; Lymphœdème secondaire; Mastectomie; Mastectomy; Persistant seroma; Resistant seroma; Secondary lymphedema; Sentinel lymph node; Sérome récalcitrant; Traitement radical du cancer du sein; Vert d’indocyanine.