IMMEDIATE LYMPHATIC RECONSTRUCTION FOR THE PREVENTION OF BREAST CANCER-RELATED LYMPHOEDEMA

Breast cancer-related lymphoedema (BCRL) is a chronic and often irreversible condition that affects a substantial proportion of women following axillary surgery and regional nodal irradiation. It results in progressive arm swelling, discomfort, reduced range of motion, recurrent cellulitis, and psychological distress, imposing a considerable burden on patients and health systems. Traditional management is largely reactive, aiming to alleviate symptoms rather than prevent onset. Immediate lymphatic recon-struction (ILR) has emerged as a preventive microsurgical approach performed concurrently with ax-illary lymph node dissection (ALND). The technique involves creating one or more lymphaticovenous anastomoses (LVAs) to restore lymphatic flow from the arm into adjacent venules, often using venous coupler devices. Multiple prospective cohorts, meta-analyses, and early randomised data show that ILR reduces the risk of BCRL from 20-40% after ALND to under 5% in most series, without increasing operative morbidity. The technique has been shown to be technically feasible, oncologically safe, and well tolerated. This chapter reviews the epidemiology, pathophysiology, patient selection, operative technique, postoperative surveillance including bioimpedance spectroscopy (BIS; L-Dex), published outcomes, complications, and health-economic considerations.