How surgeons are working to prevent a major breast cancer complication

CHICAGO — Lymphedema can be a debilitating side effect of breast cancer surgery when lymph nodes are removed. It can cause swelling and pain and there’s no cure. But now, innovative surgeons are taking a different path to prevent the problem from happening in the first place.

“Last year in August I was doing my monthly self-exam and I felt a lump and I was immediately shocked and kind of frozen,” Jordan Kost, breast cancer survivor, said.

A breast cancer diagnosis is difficult enough, add to that the surgical removal of the breast tumor, then a whole host of residual issues that impact quality of life for survivors. Kost felt the weight of a heavy burden.

“My scan did show I had some lymph node activity so that started the conversation with Dr. Seth about the lymph node reconstruction,” Kost said.

 Along with her double mastectomy, Kost was offered an opportunity to avoid one of the most common complaints of breast cancer patients who have had lymph nodes removed or undergone radiation, lymphedema. The flow of lymphatic fluid is interrupted by surgery and treatment.

“When those lymph nodes are removed it basically interrupts the flow from the extremity to the rest of the body and that fluid overtime backs up down the arm,” Dr. Akhil Seth, NorthShore University HealthSystem, plastic and reconstructive surgeon, said.

“I’m a marathoner a six-time Chicago marathoner,” Kost said. “When I consulted with Dr. Seth I said whatever you gotta do, I want to run a marathon again and he was amazing he said I know exactly what we need to do.”

Seth, a reconstructive breast surgeon, helps women feel whole again after breast cancer and for him that means thinking beyond the breast itself. He helped pioneer a technique at NorthShore University HealthSystem to prevent lymphedema.

“We have figured out a way – building off people who have taught me how to do the procedure — to basically at the time the lymph nodes are taken out to reconstruct the whole lymphatic system to basically give that fluid somewhere to go,” Seth said. 

First, they use dye to highlight the tiny lymph nodes. Then with microscopic surgery, doctors search for small veins to reroute the lymphatic system.

“Everyone’s lymphatics eventually drain into your veins. We’re basically rerouting the plumbing so to speak to get fluid to drain sooner,” Seth said.

After 30 patients over more than a year, so far success.

“There really is no downside to this the risk of the procedure I’m doing here is minimal. It’s a little added time in the operating room it takes me about an hour or so but short of that the actual surgical risk is low, but benefit is high,” Seth said.

“I feel incredibly grateful to have been given the opportunity to have it,” Kost said.

Up to 40% of breast cancer patients who have lymph nodes removed go on to develop lymphedema. In people who have this surgery, that number drops to only 2% to 4%.