{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:20:13Z","timestamp":1789708813243,"version":"4.0.1"},"reference-count":41,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2022,11,26]],"date-time":"2022-11-26T00:00:00Z","timestamp":1669420800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Multiple surgical alternatives are available to treat breast cancer\u2010related lymphedema (BCRL) providing a variable spectrum of outcomes. This study aimed to present the breast cancer\u2010related lymphedema multidisciplinary approach (B\u2010LYMA) to systematically treat BCRL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Seventy\u2010eight patients presenting with BCRL between 2017 and 2021 were included. The average age and BMI were 49.4\u2009\u00b1\u20097.8\u2009years and 28.1\u2009\u00b1\u20093.5\u00a0kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , respectively. Forty patients had lymphedema ISL stage II (51.3%) and 38 had stage III (48.7%). The mean follow\u2010up was 26.4\u00a0months. Treatment was selected according to the B\u2010LYMA algorithm, which aims to combine physiologic and excisional procedures according to the preoperative evaluation of patients. All patients had pre\u2010 and postoperative complex decongestive therapy (CDT).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Stage II patients were treated with lymphaticovenous anastomosis (LVA) (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a018), vascularized lymph node transfer (VLNT) (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a012), and combined DIEP flap and VLNT (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a010). Stage III patients underwent combined suction\u2010assisted lipectomy (SAL) and LVA (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a036) or combined SAL and VLNT (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a02). Circumferential reduction rates (CRR) were comparable between patients treated with LVA (56.5\u2009\u00b1\u20098.4%), VLNT (54.4\u2009\u00b1\u200910.2%), and combined VLNT\u2010DIEP flap (56.5\u2009\u00b1\u20093.9%) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u2009.05). In comparison to LVA, VLNT, and combined VLNT\u2010DIEP flap, combined SAL\u2010LVA exhibited higher CRRs (85\u2009\u00b1\u200910.5%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001). The CRR for combined SAL\u2010VLNT was 75\u2009\u00b1\u20098.5%. One VLNT failed and minor complications occurred in the combined DIEP\u2010VLNT group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The B\u2010LYMA protocol directs the treatment of BCRL according to the lymphatic system's condition. In advanced stages where a single physiologic procedure is not sufficient, additional excisional surgery is implemented. Preoperative and postoperative CDT is mandatory to improve the outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/micr.30990","type":"journal-article","created":{"date-parts":[[2022,11,26]],"date-time":"2022-11-26T09:36:50Z","timestamp":1669455410000},"page":"427-436","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["The breast cancer\u2010related lymphedema multidisciplinary approach: Algorithm for conservative and multimodal surgical treatment"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4646-2676","authenticated-orcid":false,"given":"Pedro","family":"Ciudad","sequence":"first","affiliation":[{"name":"Department of Plastic, Reconstructive and Burn Surgery Arzobispo Loayza National Hospital  Lima 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