Autologe Brustrekonstruktion und lymphorekonstruktive Chirurgie nach Mastektomie bei Mammakarzinom-assoziiertem Lymphödem

Zusammenfassung

Das Lymphödem der oberen Extremität nach Mammakarzinom führt unbehandelt durch chronisch-progredienten Gewebeumbau zu signifikanten Einschränkungen von Lebensqualität und Funktion, und kann mit Latenzzeit noch Jahre nach der initialen Tumorbehandlung auftreten. Sowohl die alleinige autologe Brustrekonstruktion als auch die lymphatische Chirurgie zur Behandlung des Lymphödems sind wirksam bei der Reduktion von Volumen, und Umfang sowie funktionellen Beeinträchtigungen und verbessern die lokale Immunkompetenz, Körperbild und -integrität sowie Lebensqualität. Physiologische Verfahren, einschließlich lymphovenöser Anastomsosen (LVA) und vaskularisierte Lymphknotentransplantation (VLKT), adressieren die Neuordnung und Optimierung des Lymphabstroms innerhalb der betroffenen Extremität. Bei Patientinnen mit Mammakarzinom-assoziiertem Lymphödem nach Ablatio und geplantem Brustaufbau bietet die autologe Brustrekonstruktion in Verbindung mit lymphatischer Mikrochirurgie durch VLKT, LVA oder die Kombination beider Verfahren die Option der ganzheitlichen und einzeitigen Wiederherstellung. Die lokale Narbenlösung in der Axilla ist Teil des chirurgischen Konzepts für die Rekrutierung von Armlymphkollektoren und Vorbereitung des Empfängerbetts des VLK Transplanats. In diesem Artikel werden die Indikationen, die präoperative Diagnostik, die Operationstechnik, die Ergebnisse sowie Tipps und Tricks zur Durchführung der Kombination als auch der einzelnen Verfahren dargestellt.

Abstract

Breast cancer-related lymphedema of the upper extremity is the most significant non-oncological complication of tumour therapy, leading to functional impairment and impacting patients’ quality of life. Autologous breast reconstruction per se effectively reduces incidence and stage of lymphedema after breast cancer treatment by surgical angiogenesis. In addition, modern surgical techniques for treating lymphedema are effective in reducing limb volume, circumference and functional impairment, and improving patients’ quality of life, body image, integrity and local immunocompetence. Reconstructive surgery, including lymphovenous anastomoses (LVA) and vascularised lymph node transfer (VLNT), have been shown to rearrange or restore lymphatic flow and prevent stage progression. For patients with breast cancer-related lymphedema after mastectomy, autologous breast reconstruction in conjunction with lymphatic microsurgery using VLNT, LVA or a combination of these procedures offers the option of holistic and single-stage restoration in modern senology. Extensive scar release in the axilla is a crucial component of the surgical technique, aiming to prepare the recipient bed for the VLN transplant and to allow for the functional recruitment of remaining lymph vessels of the upper extremity. This article presents the indications, preoperative diagnostic evaluation, surgical techniques and precautions, complications and results of combined lymphatic and breast restoration.

Schlüsselwörter

Mammarekonstruktion, Brustchirurgie - Lymphgefäß, Körperregion und Anatomie - Mamma, Körperregion und Anatomie - obere Extremität, Körperregion und Anatomie - Mikrochirurgie der Lymphgefäße, Mikrochirurgie

Key words

breast reconstruction - lymphatic vessel - breast - upper extremity - microsurgery of lymphatic vessels

Publication History

Received: 03 January 2022

Accepted: 22 May 2022

Article published online:
09 August 2022

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