Nebraska Medicine | Fred & Pamela Buffett Cancer Center is the only Comprehensive Cancer Center of Excellence in Nebraska for lymphedema – and was one of the first 20 such centers in the world.
The designation, awarded by the Lymphatic Education & Research Network, reflects the program’s commitment to continuing education, multidisciplinary coordination and the full spectrum of surgical and therapeutic options for lymphedema patients.
Plastic surgeon Sean Figy, MD, sees patients across the lymphedema continuum, from subclinical detection through complex reconstruction.
When to refer and what to look for first
Dr. Figy encourages early referral, particularly for patients with known risk factors, including lymph node dissection, chemotherapy or radiation history.
“I have a very low threshold for referral,” he says. “And the things that trigger my thought process on lymphedema are not necessarily swelling initially, but early fatigue, cramping in the forearm and a ring that just doesn’t fit well.”
Lymphedema – classically defined by measurable volume increase – can actually now be detected prior to the onset of swelling. Stage 0 and stage 1 patients respond best to surgical intervention and may be spared lifelong compression garment dependence.
Helpful information at the time of referral includes:
- Venous workup results.
- Cancer treatment history.
- Details on lymph node removal and radiation.
Referrals should be placed for both lymphedema therapy and lymphedema surgery, though a single referral to therapy is sufficient, as the therapist can facilitate the surgical consult.
Building the case for early intervention
For patients undergoing lymph node dissection, Dr. Figy performs immediate lymphatic reconstruction (ILR) at the time of cancer surgery. This involves identifying and rerouting cut lymphatic channels from the extremity before they can back up and cause swelling.
“If we give lymphatics that have been cut an outlet, a place to drain, then we have a better chance of preventing lymphedema from developing,” he says.
ILR is an active area of research for Dr. Figy and his team, with ongoing outcomes databases tracking its use in breast, gynecologic and urologic oncology patients – populations where lower-extremity lymphedema risk is significant.
Surgical options
For lymphedema patients, two primary physiologic procedures are offered:
- Lymphovenous bypass: Reroutes lymphatic flow into the venous system. Patients typically see improvement within two to three months, though some therapies are withheld immediately post-op to protect surgical repairs.
- Vascularized lymph node transplant: Relocates functioning lymph node tissue to the affected area, stimulating new lymphatic vessel growth. Maximal benefit takes approximately two years as the transplanted tissue integrates and new channels develop.
Patients who are not candidates for physiologic procedures have access to the full range of debulking options, as well as custom compression garment fitting through the lymphedema therapy program.
A multidisciplinary team
The Comprehensive Cancer Center of Excellence designation requires more than credentials. It demands coordinated care across specialty-trained surgeons, lymphedema therapists, geneticists and imaging specialists.
“When you have all the members of the same team talking to each other, it allows for cross-pollination,” Dr. Figy says. “They’ll have ideas that help me, and I’ll have ideas that help them. It puts the patient in the mind’s eye of all of us together.”
To refer a patient, or for more information, email physicianoutreach@nebraskamed.com or call 402.559.5600.