{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T23:34:15Z","timestamp":1777073655465,"version":"3.51.4"},"reference-count":96,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin Plast Surg"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Breast cancer\u2013related lymphedema (BCRL) remains a common and morbid consequence of axillary lymph node dissection (ALND) and radiotherapy (RT). As reconstructive microsurgery has advanced, there is increasing interest in integrating lymphatic surgery into breast cancer pathways\u2014both as primary prevention at the time of ALND and as secondary treatment combined with breast reconstruction. We performed a systematic review to synthesize current concepts, techniques, and evidence supporting integrated breast and lymphatic reconstruction. PubMed and Web of Science were searched from inception to December 27, 2025. Eligible studies included breast cancer patients undergoing lymphatic surgery in preventive and\/or therapeutic settings (e.g., vascularized lymph node transfer [VLNT] integrated into breast reconstruction). A total of 89 studies met inclusion criteria, encompassing randomized and prospective comparative studies, retrospective cohorts, health services analyses, technical reports, and case series. Two dominant integration paradigms emerged. Preventive integration most commonly involved immediate lymphatic reconstruction (ILR)\/lymphatic microsurgical preventive healing approach (LYMPHA) performed at ALND, with reported feasibility and evolving evidence on risk reduction, learning curve, and technical refinements (mapping strategies, recipient vein selection, coupler-assisted techniques, and vein graft use). Staged pathways\u2014including delayed ALND\u2014can still accommodate ILR when suitable lymphatics and recipient veins remain identifiable. Therapeutic integration primarily comprised VLNT incorporated into autologous breast reconstruction (often DIEP-based) and popularized within the concept of total breast anatomy restoration (TBAR), with generally favorable reports on limb volume, cellulitis burden, and quality of life, albeit largely observational. Emerging omental strategies suggest a potential role for preventive VLNT but remain in early stage. Implementation studies highlight access barriers, and economic analyses suggest ILR may be cost-effective in select high-risk populations. BCRL management is evolving toward integrated, continuum-based intervention through preventive ILR and reconstructive VLNT\/TBAR strategies. Standardized outcome definitions, longer follow-up\u2014particularly accounting for RT\u2014and implementation-focused research are required to optimize patient selection and enable scalable, equitable adoption.<\/jats:p>","DOI":"10.1055\/a-2795-0088","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T23:53:23Z","timestamp":1770422003000},"page":"103-112","source":"Crossref","is-referenced-by-count":0,"title":["Incorporating Lymphedema Reconstruction into Breast Reconstruction: Concepts, Approach, and Systematic Review"],"prefix":"10.1055","volume":"40","author":[{"given":"Allen Wei-Jiat","family":"Wong","sequence":"additional","affiliation":[{"name":"Plastic Reconstructive & Aesthetic Surgery Service, Department of Surgery, Sengkang General Hospital, Singapore"},{"name":"Singhealth Duke-NUS Musculoskeletal Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadia Hui-Shan","family":"Sim","sequence":"additional","affiliation":[{"name":"Plastic Reconstructive & Aesthetic Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jung-Ju","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan, Taiwan"},{"name":"Breast Cancer Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"2007","DOI":"10.1245\/s10434-024-16640-8","article-title":"Preventing breast cancer-related lymphedema: a comprehensive analysis of a 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enhances quality of life in breast cancer-related lymphedema: final Phase I trial results","volume":"111","author":"S Pajula","year":"2025","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"05","key":"ref8","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1016\/j.bjps.2010.06.014","article-title":"Objective improvement in upper limb lymphoedema following ipsilateral latissimus dorsi pedicled flap breast reconstruction\u2014a case series and review of literature","volume":"64","author":"M A Abbas Khan","year":"2011","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1007\/s13193-018-0731-0","article-title":"Lymphatic microsurgical preventing healing approach (LYMPHA) for prevention of breast cancer-related lymphedema\u2014a preliminary report","volume":"9","author":"J Agrawal","year":"2018","journal-title":"Indian J Surg 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