Preventing lymphedema in breast cancer surgery: a study using fluorescent imaging to identify lymphatic vessels and microsurgery to join them to veins during lymph node removal

The intervention involves performing immediate lymphaticovenous anastomosis (ILA) at the time of axillary lymph node dissection (ALND) for breast cancer. Indocyanine green (ICG) fluorescence axillary reverse mapping (ARM) is used intraoperatively to identify lymphatic vessels draining the upper limb. ICG (2.5 mg/mL) is injected intradermally into the upper inner arm, and a near-infrared fluorescence imaging system is used to visualize the lymphatic channels. Identified lymphatic vessels are preserved and anastomosed to adjacent veins using supermicrosurgical techniques under high magnification. The procedure is performed by a trained plastic and reconstructive surgeon. The intervention is typically completed within 45 to 60 minutes. Adherence to the intervention is monitored and documented in the operative report, including details of lymphatic identification and the number of anastomoses performed. No additional lymphedema-specific therapies are administered postoperatively.