The Impact of Vascularized Lymph Node Transfer in Reducing the Rate of Cellulitis in Patients with Breast Cancer-Related Lymphedema

Poorly managed breast cancer-related lymphedema (BCRL) may lead to recurrent cellulitis. Advances in the management of lymphedema have evolved beyond conservative decongestive therapy to include vascularized lymph node transfer (VLNT). Herein, we analyzed the impact of VLNT in the reduction of upper extremity cellulitis in breast cancer survivors. We reviewed all patients at our institution who had breast cancer, underwent mastectomy, experienced upper extremity lymphedema, and proceeded with VLNT from 2017 to 2021. Patients were included if they had 1 or more episodes of cellulitis within the year prior to VLNT and were followed for at least 12 months. We included 66 patients that fulfilled our strict inclusion criteria with a median age of 57 years (IQR, 23-76 years). All patients were female and most were White (88%), with a mean (± SD) body mass index of 29.4 ± 6.7 kg/m2. Many presented with invasive ductal carcinoma (82%), had axillary lymph node dissection (98%), received chemotherapy (94%) and radiation therapy (86%). VLNT was performed at a median of 92 months after mastectomy (IQR, 32-156 months). Overall, 58 (88%) patients remained infection-free with an infection rate decrease from an average of 2.27 before the index VLNT to 0.17 (P < .0001) after VLNT. VLNT is associated with significantly decreased cellulitis rates and should be considered as part of the infectious diseases armamentarium for the treatment of recurrent upper extremity cellulitis due to BCRL without adequate clinical improvement to conservative management alone.