@article{ABS9846,
author = {Marie Dohet and Vanessa Marron Mendes and Michela Schettino},
title = {Algorithmic approach to lymphedema surgery: a narrative review},
journal = {Annals of Breast Surgery},
volume = {10},
number = {0},
year = {2026},
keywords = {},
abstract = {Background and Objective: Lymphedema is a chronic, progressive disorder that significantly impairs quality of life and functional capacity. It includes both primary lymphatic dysplasia and secondary forms, most commonly breast cancer-related lymphedema (BCRL). This review aims to synthesize current knowledge on lymphedema pathophysiology and classification and to present a structured diagnostic workup supporting an algorithmic approach to surgical management.Methods: A narrative review of the literature was performed to integrate evidence on clinical staging, functional imaging, tissue composition, and surgical decision-making in primary and secondary lymphedema. Particular attention was given to BCRL and to studies relevant to phenotype-driven treatment selection. PubMed was searched for English-language studies published up to March 2, 2026, addressing the pathophysiology, classification, imaging modalities, and surgical management of primary and secondary lymphedema. The search strategy combined MeSH terms and free-text keywords, including “lymphedema”, “lymphatic surgery”, “lymphaticovenous anastomosis”, “vascularized lymph node transfer”, “suction-assisted lipectomy”, and “lymphatic imaging”. Additional studies were identified through manual screening of reference lists.Key Content and Findings: An effective surgical strategy requires more than clinical staging alone, because staging does not fully capture pathophysiology or tissue composition. Integrating clinical examination with functional imaging and tissue analysis helps distinguish fluid-predominant, mixed, and adipose-predominant phenotypes and supports selection among physiologic, reductive, or hybrid procedures. This phenotype-driven framework is especially relevant in BCRL, where individualized planning is essential.Conclusions: A structured, phenotype-based algorithm that combines pathophysiology, clinical staging, functional imaging, and tissue composition may improve surgical decision-making in lymphedema. This approach may help optimize patient selection and tailor treatment more effectively, particularly in breast cancer-related disease.},
issn = {2616-2776}, url = {https://abs.amegroups.org/article/view/9846}
}