Improving the quality of life in those with lymphoedema

Written by: Mr Damir Kosutic
Edited by: Bronwen Griffiths

Lymphoedema is a chronic condition that can be debilitating to live with. It is characterised by the swelling and the collection of fluid in upper and lower limbs. It can result from previous cancer surgery in which lymph nodes were removed. This is common in surgeries that treat breast cancer, melanoma, gynaecological and urological cancer treatments. There is also primary and congenital lymphoedema which develops for reasons not yet known. As our understanding of this disease improves, and as advances in microsurgery take place, we are better able to surgically treat lymphoedema.

Previously, some patients would have long-term disability and physical impairment as a result of their lymphoedema. However, now we have a variety of advanced microsurgical and supermicrosurgical techniques that can significantly improve their quality of life. As an example, we can look at how breast cancer surgery has changed to avoid the complication of lymphoedema in patients.

DIEP flap breast reconstruction with lymphoedema prevention and treatment:

The DIEP flap procedure (deep inferior epigastric artery perforator flap) is the mainstay option to reconstruct breasts using the patient’s own tissue. Whilst it is a complex technique, recently it has undergone improvements to integrate a vascularised lymph node transplant into the procedure to prevent lymphoedema from developing post-surgery.

This new procedure can be used for patients undergoing a mastectomy and breast reconstruction, as well as patients who have already had their breast cancer surgery and, as a result, suffer from lymphoedema. In fact, Mr Damir Kosutic is one of the rare plastic surgeon s in the UK and Europe who offers this revolutionary technique that achieves a ‘natural breast reconstruction’, alongside lymphoedema prevention or treatment.

This technique can be hugely beneficial to patients, who are saved from having to live the debilitating reality of this disease. It also allows patients to have one surgery which completes the mastectomy, the reconstruction and the prevention of lymphoedema.

How does a lymph node transplant treat and prevent lymphoedema?

A lymph node transfer is extremely cutting-edge for treating and preventing lymphoedema in cancer patients. Selected lymph nodes are harvested with their respective blood supplies, which are then transferred into the patient’s affected upper or lower limbs.

To ensure the transferred lymph nodes have a healthy supply of blood, they are reconnected using a high-resolution microscope and microsurgical instruments, which Mr Damir Kosutic is an expert in. Additionally, MRI scans and CT scans are used to identify the new blood supply for each lymph node transfer. After their transplantation, the new lymph nodes act like sponges to collect the excess fluid in the affected limbs.

Having this surgery does not require the patient to wear compressive garments at all. In addition, swelling of extremities is significantly reduced and so too is the risk of developing cellulitis and their overall quality of life.

By Mr Damir Kosutic
Plastic surgery

Mr Damir Kosutic is a top consultant plastic and reconstructive surgeon based in Manchester. An internationally acclaimed expert in natural tissue breast reconstruction, using the DIEP flap technique (with or without lymph node transplant), lymphoedema microsurgery, reconstruction after skin cancer, liposuction and abdominoplasty. He is also one of the few plastic surgeons in the UK offering migraine headache treatment using Botox and surgery.

Mr Kosutic possesses a PhD and Master's degree in Biomedical Sciences and is European Board certified in Plastic and Reconstructive Surgery. He completed several prestigious fellowships around the world, including St Pau Hospital in Barcelona with pioneer Professor Jaume Masia and New York with Dr Robert Allen, inventor of DIEP Flap. Now an expert in the field of microsurgical breast reconstruction and lymphoedema treatment, Mr Kosutic regularly lectures around the world and has widely published in the field of complex cancer reconstruction including the use of CT angiogram and MRI for planning of DIEP Flap to significantly improve surgical outcomes for breast cancer patients.

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