The Pedicled Lateral Thoracic Lymph-Adipofascial Flap: A Nonmicrosurgical Lymph-Interpositional Technique to Prevent Upper Limb Lymphedema After Axillary Lymph Node Dissection-Preliminary Outcomes.

BACKGROUND: Breast cancer-related lymphedema (BCRL) remains a common and morbid complication after axillary lymph node dissection, particularly in patients receiving regional nodal irradiation. Although microsurgical preventive strategies such as the lymphatic microsurgical preventive healing approach are effective, their widespread adoption is limited by technical complexity and resource requirements. This study evaluated the feasibility, safety, and preliminary outcomes of a standardized nonmicrosurgical lymph-interpositional technique using a pedicled lateral thoracic lymph-adipofascial flap (LT-LAF).

METHODS: This retrospective, hypothesis-generating study included 55 consecutive breast cancer patients at high risk for BCRL who underwent axillary lymph node dissection with immediate axillary reconstruction using a pedicled LT-LAF between October 2020 and January 2024. Lymphedema was defined by patient-reported symptoms and a relative volume change ≥ 10% and classified according to International Society of Lymphology criteria.

RESULTS: After a median follow-up of 24 months, 6 patients (10.9%) developed mild lymphedema (ISL stage I). No moderate or severe lymphedema and no axillary nodal recurrences were observed during follow-up. All flaps survived completely, with no major flap-related or donor-site complications. The LT-LAF harvest and inset added a mean operative time of 35 ± 6.4 minutes.

CONCLUSIONS: Immediate axillary reconstruction using a pedicled LT-LAF is a safe, simple, and reproducible nonmicrosurgical technique with a favorable preliminary signal for mitigating BCRL risk in high-risk patients. These findings support further prospective and comparative studies to define its role within contemporary lymphedema prevention strategies.