The new technique, called ‘lymphatic bypass supermicrosurgery’, has been used at The James Cook University Hospital for women undergoing surgery to treat breast cancer. It prevents the risk of secondary lymphoedema – a chronic condition which causes swelling in people’s limbs.
The disease affects 50% of women who have undergone ‘axillary clearance’ surgery – where cancer has spread to the lymph nodes in the armpit. That’s approximately 36 out of the 72 women who receive this surgery every year across University Hospitals Tees sites.
This new surgical technique reduces that impact to 4% of women.
Two women under the care of the Middlesbrough hospital have so far undergone this new technique, performed by plastic and breast reconstruction surgeon Mr Mohamed Abdelrahman. He has been working closely with therapy radiographer and lymphoedema practitioner Kate Gowans and breast surgeons to identify women who are at particularly high risk of lymphoedema.
Mr Abdelrahman said: “This procedure came to light very, very recently and there are very few centres in the UK currently offering it.
“The first lady to have this procedure with us last year had a very high risk of developing lymphoedema. She’s doing remarkably well now – Kate sees her regularly and, nine months on, she shows no signs of it.
“The procedure only takes one and a half hours but it impacts the rest of their life.”
Axillary surgery disrupts the lymphatic vessels in the armpit – which helps the body remove waste and bacteria as part of the immune system. This disruption means this natural waste doesn’t drain as it should and causes swelling to the arm, known as lymphoedema.
This new supermicrosurgery ‘plugs’ these vessels – which are around 0.5mm thick (less than a hair) – into the veins for the body to filter as usual. Mr Abdelrahman carries out this technique during breast reconstruction surgery immediately after mastectomy (removal of the breast or breasts) and removal of the armpit lymph glands.
Kate said: “When I first heard about this procedure, my mind was just blown. It amazes me that surgeons have these incredible skills that can so benefit our patients.
“Lymphoedema is a horrible, painful side effect of cancer treatment. I’ve had patients say to me ‘I thought it was just a normal side effect of all my treatment’. Yet the impact it has is huge. Patients need to buyer larger sized clothes to accommodate a swollen arm, they feel self conscious about it, especially if they’ve lost a breast and their hair as well. This condition is lifelong, and only manageable – which for some patients, is devastating.
“To have this new procedure for women in Teesside is hugely exciting. It’s going to be life-changing.”
Mr Abdelrahman and Kate are working closely together to roll this procedure out to as many women being treated for breast cancer as possible.
Mr Abdelrahman continues: “Kate, the breast surgeons and I talk about the service a lot. Short-term, we want to be able to offer it to every patient who’s undergoing axillary clearance with us.
“Once we’ve established a sustainable service, our hope is that we’ll be in the position to offer it as a secondary procedure to women who already have established lymphoedema as a result of surgery.
“If we can make life easier for these ladies, let’s do it.”