Lymphoedema treatment (lymph node transfer)

The main symptom of lymphoedema is swelling. This is most common in the arms or legs but can also affect other parts of the body. Swelling can be mild or severe and may come and go. It often gets worse during the day and improves at night. Untreated lymphoedema usually gets worse over time.

Other symptoms in the affected body part may include:

• A heavy or aching sensation
• Difficulty moving
• Your clothes or jewellery may feel tighter than usual
• Skin changes such as puffy, red, hard, tight, or thickened skin, skin folds, or wart-like growths
• Your arms or legs may appear to be different sizes
• Leakage of fluid through the skin
• Frequent or repeated skin infections
• If you have lymphoedema in your head or neck, you may experience problems swallowing or speaking

Lymphoedema has a variety of causes. There are two main types of lymphoedema - primary lymphoedema and secondary lymphoedema.

Primary lymphoedema

This is a rare type of lymphoedema that occurs when a genetic defect affects the development of the lymphatic system. Primary lymphoedema usually starts during infancy, adolescence, or early adulthood, but can occur at any age.

Secondary lymphoedema

This is the most common type of lymphoedema and occurs when the lymphatic system is damaged due to surgery, trauma, or radiation therapy.

Secondary lymphoedema is most common in people who have had breast cancer treatment.

Secondary lymphoedema may be caused by:

• Cancer — some types of cancer or cancer surgery that affects the lymph nodes such as breast cancer, vulval cancer, penile cancer, head and neck cancer or skin cancer
• Radiation therapy—may cause scarring and damage to your lymphatic system
• Trauma —  injury or surgery may damage lymphatic vessels under your skin, causing lymphedema
• Infection — some types of infection may cause damage to the lymphatic system
• Obesity — being obese can increase pressure on your lymph vessels and nodes which may affect lymphatic drainage
• Inactivity — moving your legs acts as a pump for your lymphatic circulation, and not moving enough can reduce the circulation of lymph, causing lymphoedema
• Vascular disease — your blood vessels (vascular system) carry around 80% to 90% of the fluid around your body. Chronic blood vessel disease can affect the movement of fluid and result in lymphoedema
• Tumours — some tumours can block the drainage of lymph
• Heart conditions — heart conditions such as congestive cardiac failure may cause lymphoedema
• Kidney disease — your kidneys remove extra fluid and waste products from your body. If you have kidney disease, your body may not remove extra fluid effectively resulting in lymphoedema
• Pelvic surgery — surgery to remove the lymph nodes in your pelvis may cause lymphedema

Your consultant will ask you about your symptoms, general health and medical history and perform a physical examination. They may measure your limbs with a tape measure to see if one limb is larger than the other.

How is a diagnosis made?

Lymphoedema can often be diagnosed from your symptoms, medical history, and physical examination.

In some cases, your consultant may order further tests or scans including:

• Perometry — uses an infra-red light to measure the outline of your affected limb and calculate its volume
• Water displacement – your affected limb is placed in a tank of water and the amount of water that's displaced is measured to calculate the volume of your limb
• Bioimpedance spectroscopy — uses an electrical current to measure the water content in your affected tissues
• Lymphoscintigram – a radioactive dye is used to track movement through your lymphatic system and check for any blockages
• Ultrasound — uses high-frequency sound waves to measure blood flow through the affected area. It can be used to check for blockages or rule out other possible causes of swelling, such as blood clots
• Magnetic resonance imaging (MRI) —shows 3D images of inside your body to check whether something, such as a tumour, is putting pressure on your lymphatic system
• Computed tomography (CT) scan — shows cross-sections of your body’s structures and may be used to check whether something is putting pressure on your lymphatic system
• Genetic testing — Your consultant may refer you for genetic testing if they suspect that you have primary lymphoedema

Why is this first consultation so important?

At Circle Health Group, your first appointment is very important as it’s where your consultant will ask you about your symptoms, perform a physical examination, order any necessary tests, provide a diagnosis, and discuss possible treatments.

Your first consultation is also an opportunity for you to get to know your consultant and ask any questions you may have. It is important to us that you are as well-informed and comfortable as possible during your time with us, so please discuss any questions or concerns with your consultant during your appointment.

At the end of your appointment, your consultant will discuss possible treatment options with you and decide on the best option for you, based on your symptoms, diagnosis, general health, and medical history.

Lymphoedema can be treated in several ways including non-surgical and surgical options.

Non-surgical treatments

Decongestive lymphatic therapy (DLT)

DLT doesn’t cure lymphoedema, but it can help improve your symptoms. The first stage of treatment (intensive stage) is usually every day for several weeks, followed by the maintenance stage where you continue your treatment yourself at home.

DLT involves a combination of four techniques:

• Compression bandages or garments – help reduce swelling by moving fluid out of the affected limb and minimising further build-up
• Skincare – to keep the skin in good condition and reduce the chances of infections such as cellulitis
• Exercises – your physiotherapist will teach you special exercises and movements to increase muscle strength, stimulate your muscles and improve lymph drainage
• Manual lymphatic drainage (MLD) – a specialised massage technique that stimulates the movement of fluid through the lymphatic system and reduces swelling

Surgical treatments

In some cases, surgery may be recommended to treat lymphoedema. There are several options for surgery including:

• Liposuction– removal of fat from the affected limb to reduce the size of the affected part of the body
• Lymphaticovenular anastomosis (LVA) – a procedure to restore the circulation of lymph by connecting the lymphatic vessels in the affected area to nearby veins
• Vascularised lymph node transfer (VLNT) – this is a relatively new type of microsurgery that we offer at Circle Health Group. The procedure involves transferring spare lymph nodes and their blood supply from your groin to where they are needed, improving, or curing your lymphoedema. The technique is normally used for people whose lymph nodes have been removed or irradiated as part of cancer treatment resulting in lymphoedema in a limb

Your consultant will tell you everything you need to do to prepare for your lymph node transfer surgery. If there’s anything you’re not sure about, or if you have any questions about how to prepare for your surgery, speak to your consultant or call the hospital for advice. Being well-prepared for your surgery will help to ease any anxiety you may have as well as allow your surgery and recovery to go more smoothly.

Before your surgery, tell your consultant about any medical conditions or allergies you have and any medication, including over-the-counter medicines you are taking.

Your consultant may tell you to stop taking some medications like blood thinners before your operation. This is to reduce the risk of bleeding during and after your surgery.

You will not be able to eat or drink anything from midnight on the day of your operation.

Before your lymph node transfer, you should continue to use your compression bandages or garments.

What lifestyle changes can I make before my surgery?

Being in the best possible health before your surgery can reduce the risk of complications and help speed up your recovery.

To make sure you are as healthy as possible before your surgery:

• Eat a healthy, balanced diet with plenty of fruit, vegetables, lean proteins, and whole grains
• Lose weight if you need to
• If you smoke, try to stop at least eight weeks before your surgery
• Avoid alcohol for a few days before and after your surgery. Alcohol thins the blood and can increase the risk of bleeding
• Take regular exercise

• Once the anaesthetic has taken effect, your consultant will make a small incision in your groin area
• Using a special video camera called a fluoroscope, the correct lymph nodes are identified and removed along with their supplying blood vessels
• At the recipient site (the area where the lymph nodes are being transferred to), any scarring that could be worsening your lymphoedema is released and a pocket is created for your transferred lymph nodes
• The transferred lymph nodes with their attached blood vessels are carefully attached to blood vessels in the recipient site and the blood supply is checked using the fluoroscopy camera
• Your consultant will close your incisions with dissolvable stitches and apply a sterile dressing

Lymph node transfer takes between four and eight hours.

Your consultant will give you an estimated recovery timeline based on your individual circumstances.

After your lymph node transfer, you’ll be taken to the recovery room where you’ll be monitored closely until the anaesthetic has worn off. You will have a drain in your donor site to drain any blood and fluid after your surgery. This will be removed after a day or two.

You may have some pain or discomfort for the first few days after your lymph node transfer. The nursing team will give you medication to manage this. Your consultant will prescribe painkillers and antibiotics for you to take at home.

A week after your surgery, you will need to start wearing compression bandages or your normal lymphoedema compression garment.

Before you are discharged, you’ll be given a follow-up appointment to check your progress and how your incision wounds are healing.

You should avoid putting any pressure on your recipient arm such as pulling, pushing, or lifting, for the first two weeks after your lymph node transfer. Your healthcare team may give you other instructions about which movements to avoid or restrict during your recovery.

You may be referred for physiotherapy during your recovery to help reduce swelling, strengthen your muscles, and regain your flexibility and range of motion.

How many nights will I need to stay in hospital?

You can expect to stay in hospital for between one and four days after your lymph node transfer.

Will I be able to drive home?

You will not be able to drive yourself home from hospital after your lymph node transfer. Please make arrangements for someone to collect you, or we can organise a taxi if you prefer.

How soon can I go back to work?

How soon you can go back to work after your surgery depends on your individual recovery and the type of job you do. If your job is sedentary, such as office work, you can normally expect to go back to work after around two weeks, but this may be longer if you have a manual or active job.

How soon can I drive?

You should not drive for two weeks after your lymph node transfer.

When will I be back to normal?

Recovery from any type of surgery is a gradual process that is different for everyone. You can help your recovery to go more smoothly by taking things at your own pace and following your consultant’s instructions carefully during your recovery. Call the hospital if you have any questions or concerns.

Most people are well enough to resume normal daily activities after around two weeks, can start gentle exercise after four weeks and more vigorous exercise after around six weeks. It normally takes around four to six weeks to recover fully from lymph node transfer.

It can take from several months to over a year to see the full benefits of lymph node transfer surgery.

As with all types of surgery, lymph node transfer carries a small risk of complications. Your consultant will explain all the possible risks and complications before your surgery and answer any questions you may have about your procedure. Being fully informed about the potential risks and complications of lymph node transfer will allow you to make an informed decision.

Possible complications of any surgery include:

• Bleeding
• Infection
• Blood clots
• Adverse reactions to the anaesthetic

Possible complications specific to lymph node transfer surgery include:

• Scarring
• The transfer may be unsuccessful
• Numbness (this is usually temporary)
• Haematoma (a collection of blood at the surgical site)
• Seroma (a collection of fluid at the surgical site)
• Lymphoedema at the donor site
• Poor healing of the incisions

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about lymph node transfer surgery, book your appointment online today or call a member of our team directly.

Content reviewed by Circle in-house team in March 2024. Next review due March 2027.

• Treatment. Lymphoedema NHS
• Treating Lymphoedema Johns Hopkins Medicine
• Vascularized Lymph Node Transfer for Lymphedema PubMed
• Vascularised lymph node surgery shown to cut cancer treatment-related lymphoedema swelling by almost half The Royal Marsden NHS Foundation Trust