Dr Feldman on New Approaches for Decreasing the Risk of Breast Cancer–Related Lymphedema

Sheldon Feldman, MD, chief, Breast Surgery and Breast Surgical Oncology, professor, Department of Surgery, director, Breast Cancer Services, at Montefiore Einstein Comprehensive Cancer Center, discusses new approaches for decreasing the risk of and managing breast cancer­–related lymphedema.

Feldman explains that being mindful of which patients require surgery of the axilla can help reduce the risk of lymphedema in the breast cancer population. He emphasizes that advances in the understanding of tumor biology and axillary imaging, such as ultrasound, have allowed for more accurate assessment of necessary treatments, including whether the axilla needs to be removed. This approach significantly reduces the risk of lymphedema, since avoiding surgery on lymph nodes entirely eliminates this risk, he says.

For patients who do need axillary surgery, Feldman notes that it is crucial for surgeons to have a thorough understanding of axillary anatomy. Medical education typically covers the anatomy, but practical application requires recognizing that axillary lymph nodes drain both the breast and the arm, he says. Lymphedema occurs when the lymphatic drainage of the arm is disrupted during the removal of lymph nodes.

To mitigate this, Feldman suggests that surgeons identify and preserve lymph nodes that specifically drain the arm during breast cancer surgery. Feldman explains that "smarter axillary surgery" can significantly reduce the incidence of lymphedema.

Reducing the risk of lymphedema in patients with breast cancer involves a more selective approach to axillary surgery, leveraging tumor biology, and using advanced imaging to avoid unnecessary lymph node removal, he continues. Exploring more conservative treatment methods may represent a shift towards more informed and anatomically precise surgical techniques, Feldman concludes.