Thickening of the skin and scarring that are caused by lymphedema limit range of motion and produce symptoms that lower quality of life. John R. Barbour, MD, FACS, uses his expertise as is a triple board-certified plastic and reconstructive surgeon and fellowship trained hand and peripheral nerve specialist to help men and women in the Washington, DC, area, including Fairfax, Arlington, Alexandria and surrounding communities in Virginia, with scar release surgery for lymphedema.
Axillary Scar Release
Extremity lymphedema is a painful and functionally limiting complication of breast cancer treatment most likely due to lymphatic thrombosis after lymph node resection and radiation. When lymph nodes are removed, the adjacent lymph vessels, which are now non-functional, become fibrosed.
The prevailing theory is that surgery to the underarm and chest area traumatizes the connective tissue that encases nearby bundles of blood vessels, lymph vessels, and nerves. This trauma leads to inflammation, scarring, and eventually hardening of the tissue. Over time, this may cause more serious problems with function and mobility. The cause of this condition is an interruption of the axillary lymphatics during either surgical procedures or as the effect of post-surgical radiation treatment to the axilla. Thrombosed lymphatics go through an inflammatory phase with a thickening of the vessels and temporary shortening and tightening. Often, this leads to lymphedema where the stasis gives rise to a protein-rich exudate into the interstitium which can become fibrotic.
Cord-like structures can form in the axilla, extending into the distal arm causing pain, limited shoulder ROM and functional compromise. These become attached to the axilla or chest via scar tissue. While the cording process is distinct from lymphedema, both seem to be a manifestation of the lymph stasis. Even in patients without symptoms of lymphedema, many believe that axillary webbing is a sign of injury to the lymphatic system, which could suggest an increased risk of lymphedema developing at a later time.
Axillary webbing is known to be an independent risk factor for lymphedema, and patients with early webbing symptoms should likely be evaluated for surgical and non-surgical management. Moving and stretching under the guidance of an experienced therapist can help to resolve the condition and stop the pain, although some patients do not improve despite all attempts at therapy. For these patients, surgical release of the skin and scar tissue in the axilla can help improve the lymphatic drainage from the arm.
Dr. Barbour has had good results with the release of scar tissue and significant improvements in the motion of the arm, less heaviness, and some decrease in the size of the arm. This procedure has very little risks and frequently results in an immediately noticeable improvement for the patient.
