Avoiding Lymphedema After Mastectomy - New Technology at Redeemer Health Improves Outcomes

MEADOWBROOK, Pa. – October 2022 – A new technology at Redeemer Health is helping reduce or even avoid lymphedema, nerve injury, and shoulder mobility issues in some mastectomy patients. These improved outcomes in patients with breast cancer result from leaving lymph nodes intact during surgery.

The new localization system harnesses the power of magnetics to guide decisions. Its probe works like a metal detector that, when placed near the skin, detects magnetic markers that help determine the scope of breast and lymph node surgery.

This option is particularly relevant for those with an early form of breast cancer called ductal carcinoma in situ, or DCIS, who are undergoing mastectomy. It has normally been the practice with such patients to remove sentinel lymph nodes at the time of surgery in case the cancer is invasive and has spread to those nodes. Sentinel lymph nodes are the first lymph nodes to which cancer cells are likely to spread from a primary tumor. Their removal is typically critical in determining whether a breast cancer has spread and helps set a course of treatment.

“It has a lot of advantages,” says Dr. Stacy Krisher, breast surgeon and medical director of the breast health program at Redeemer Health in partnership with MD Anderson Cancer Center at Cooper. “This is a step forward in the surgical treatment of breast cancer.” 

Dr. Krisher explains that traditionally dye mixed with radioactive material is injected into the breast to identify the sentinel lymph nodes for removal. The dye is picked up by the breast’s lymphatic system and travels through the lymphatic vessels to the lymph nodes in the patient’s armpit. When using conventional dyes, which stay in the nodes for only a couple of hours to a day, the lymph nodes must be taken out right away. 

This system, on the other hand, enables a process called delayed sentinel lymph node biopsy. A liquid tracer that has been developed specifically for sentinel node biopsies is injected before the mastectomy, and because it remains in the lymph nodes for up to 30 days, there is time to get a pathology report on the breast and determine whether sentinel lymph node removal is necessary. If the cancer is deemed non-invasive, patients can safely keep their lymph nodes. But if there’s concern that the cancer has spread, the tracer dye will still be in the sentinel nodes to guide a biopsy.

According to the system manufacturer, up to 80% of ductal carcinoma in situ (DCIS) patients do not need to have their lymph nodes removed. Leaving the nodes intact spares these patients the potential negative effects of lymph node removal, such as a fluid build-up called lymphedema.

“There are a lot of potential side effects to removing lymph nodes,” says Dr. Krisher. “It can cause lymphedema in the arm or chest wall that can be problematic and can increase the risk of having numbness. Any surgery in the axilla can further affect arm movement or extend recovery.”

The longer time frame provided by this system is critical, she says. “If we do find invasive cancer, we go back and take the lymph nodes if we need to. But we can otherwise leave them in place and avoid the risks of lymphedema, nerve injury, and shoulder mobility issues.”

Dr. Krisher has had cases in which the lymph nodes would automatically have been removed, but thanks to the new system they were preserved.

Additionally, the system provides a new way to target tumors for removal that improves comfort and convenience for patients. The magnetic marker is used to localize tumors, helping surgeons to accurately detect and remove it.