The principal therapy for lymphedema was for a long period the conservative non surgical treatment. The first surgical procedures were really invasive with obvious disfiguring surgical outcomes, leading to a partial surgical success at long term follow-up.
Nowadays the surgical option available are considerably less invasive and efficient in reducing the limb volume, the risk of developing cellulitis and necessity of compressive sleeves. The microsurgical procedure such as limphatic-venous anastomosis, lymphatico-lymphatic bypass and lymph node vascularized transfer have been shown to be effective in treating the excess lymphatic fluid component and therefore reduce the size of the affected limb. To perform such procedures, it is necessary to use magnification instruments to operate on venous and lymphatic vessels of 0.15 / 1 mm in diameter. Our research project is aimed to assess the effectiveness of prophylactic treatment by lymphatic-venous, lymphatic-lymphatic anastomosis and vascular lymph node transfer in preventing the development of lymphedema following axillary lymphadenectomy in breast cancer patients. It is now well-established, even from the constitution of "breast units", the importance of addressing the problems associated with breast cancer totally from the oncological safety to functional problems and aesthetic consideration.
Different studies are present in the literature about the efficacy of super microsurgery procedure in lymphedema treatment. Only few studyare available in the literature about the use of super microsurgery techniques for the prevention of lymphedema formation. All of these studies regards LVA procedures. None article are present in the literature about prophylactic VLNT and lymphatic-lymphatic bypass, and so there are any study which compare these three procedure in the prevention of lymphedema development. By literature review a total of 270 cases were treated with prophylactic LVA. Only 17 patients developed lymphedema during the follow-up period. Four of the 12 studies had a controlgroup comprising of 94 patients receiving no prophylactic LVA, ofwhich 53 developed lymphedema. Only four of these study regards breast cancer.
These studies are of low quality, high risk of bias and great heterogeneity in cancer type, lymphadenectomy location, and lymphedema classification, but their initial results suggest that prophylactic LVA is an effective prophylaxis for the development of lymphedema. The aim of our studies is to perform an evaluation of the effectiveness of this prophylactic treatment in comparison to patients which do not receive this kind of procedure; the evaluation will be carried out only in patient with breast cancer and so for upper limb lymphedema. A specific method for the post-operative evaluation will be performed and will be carried out by a single physician to minimize bias. Our study has also the purpose to compare the three different supermicrosurgical technique nowadays available. To carry out this study is necessary the presence of operative microscope with fluorescence module which permits the detection of these small vessels.