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Plast Aesthet Res 2021;8:[Accepted].10.20517/2347-9264.2021.30@The Author(s) 2022
Accepted Manuscript
Open AccessOriginal Article

Prophylactic lymphatic surgery: the T-LAR approach

Correspondence Address: Prof. Jaume Masià, Chief of Plastic Surgery Department, Hospital de la Santa Creu i Sant Pau; School of Medicine at Universitat Autònoma de Barcelona Sant Quintí, 89, Barcelona 08041, Spain. E-mail:


© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License (, which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.


Aim: Breast cancer-related lymphedema (BCRL) is the most significant lasting morbidity among breast cancer survivors. Targeted-lymphatic axillary repair (T-LAR) is a novel surgical approach we proposed to reduce the risk of BCRL in patients undergoing an axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB). This study evaluated the effectiveness of T-LAR approach as a lymphedema preventive Surgery.


Methods: A retrospective analysis of a prospective maintained database was performed to evaluate patients with breast cancer who underwent ALND or SLNB with T-LAR approach between January 2017 and December 2018. Patient and tumor characteristics, oncologic and reconstructive operative details, complications and lymphedema development were analyzed.


Results: T-LAR approach was performed in 55 patients with a mean age of 51.05 ± 9.42, mean body mass index (BMI) was 25.1 ± 3.63 and median of lymph nodes removed were 13 (10-17.50) during ALND. The identification rate of arm lymphatics was 100%. The number of lymphovenous anastomosis (LVA) for each patient ranged from 0-3, 15 patients (27.3%) had 1 LVA and 26 patients (48.1%) had more than 1 LVA while in 14 patients (25.5%) no need for immediate lymphatic repair. Two patients developed lymphedema (3.6%) with median follow-up was 2.3 years.


Conclusion: The T-LAR approach is a novel, safe and reliable prophylactic intervention that significantly can decrease the incidence of BCRL as it provides maximal preservation of lymphatic continuity, identification of transected lymphatics, and reestablishment of upper extremity lymphatic drainage pathways.

Cite This Article

Abdelfattah U, Pons G, Masià J. Prophylactic lymphatic surgery: the T-LAR approach. Plast Aesthet Res 2021;8:[Accept].

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