Overview
LVA with axillary lymph node clearance
The lymphatic system is a series of channels in your body, which can drain fluid from your body tissues. Lymph is a milky liquid that helps to fight infection.
Each area of the body drains lymph into nodes, usually the group of nodes that is closest. For arms, the nearest nodes are usually in the armpit. These are called your axillary nodes.
Sometimes we have to remove your lymph nodes as part of cancer treatment. This can result in disruption of the channels that remove the lymph from your arm, and drain it into the veins in your chest.
This disruption can result in lymphoedema. This is a life-long swelling of the affected limb and can cause:
- your skin to become thicker
- the area to be more likely to get infections (and uncontrolled infections can make the swelling worse)
- you to have mobility problems if your arm gets much larger
Lymphaticovenous anastomosis (LVA)
LVA is surgery to make a connection between a lymphatic channel and a vein. This should allow the lymph fluid to drain from your arm into a vein in your armpit, avoiding the channels that are no longer working.
The LVA is done through a cut (incision) in your armpit.
A plastic surgeon will identify the draining lymphatic channels in your armpit by using a dye that is injected. These lymphatics will then be bypassed.
The wound will be closed with dissolvable stitches (sutures). You might notice staining from the dye on your upper arm, which can last for a few months.
This surgery is usually done as a day case, which means you do not need to stay in hospital over night.
Benefits of having LVA
After having axillary lymph nodes removed, your risk of developing lymphoedema in the affected side increases by 25%. This risk is increased if you are having radiation as part of cancer treatment.
An LVA can halve the risk of developing lymphoedema after your nodes are removed.
Risks of having an LVA
All surgery has general risks, and specific risks related to the procedure being done.
Having an LVA at the same time, does not change the usual risks of having the axillary lymph node clearance on its own.
Please read our information about axilliary lymph node clearance. If you do not have a copy, please ask a doctor or nurse looking after you.
There is a small chance (1 in 100 patients) of an allergic reaction to the dye used as part of this procedure. If you have a reaction, we will treat you immediately.
Other treatment options
There is currently no cure for lymphoedema. This procedure should reduce the risk of lymphoedema, and the complications associated with it.
Preparing for LVA surgery
The surgery will be done at the same time as your lymph node clearance, so you should follow the instructions given to you by the breast team.
You can read information about having surgery at our hospitals.
Asking for your permission (consent)
We want to involve you in decisions about your care and treatment. If you decide to go ahead with your procedure or treatment, we will ask you to sign a consent form. This states that you understand what it involves and agree to have the treatment.
Read more about our consent process.
After LVA
This procedure is done at the same time as your axillary node clearance, so you should be able to go home on the day of surgery or the day after.
We expect you to rest for 24 to 48 hours after the surgery. You can shower the day after surgery.
After the surgery you should not move your arm sideways above shoulder height for 2 weeks.
You must not do any heavy lifting (anything over 2kg – equivalent to a 2 litre bottle of drink) for 6 weeks.
Contact us if you have:
- increasing pain in your arm
- any redness or discharge from the wounds
If it is out of hours, go to your nearest emergency department (A&E). Any doctor who treats you can contact us at any time, phone 020 7188 7188, and ask for the on-call plastic surgeon.
Pain
You will have some discomfort in your arm for 48 hours after the procedure.
The anaesthetist will speak to you before your surgery, and will discuss pain relief with you. We will manage your pain while you are in hospital, so please let us know if you are getting pain.
We will give you some painkillers when you leave hospital.
Driving
You should only drive again when you are free of pain and can do an emergency stop comfortably. Check with your insurance company to make sure you are covered to start driving again. They might refuse to meet a claim if they feel you have driven too soon.
If you are not sure about when to start driving again, please contact your GP.
Returning to work
Your surgeon will talk to you about this, but it will depend on how physical your job is.
Follow-up appointments
You will be reviewed in the breast clinic a week after surgery. The nurses will check the wound sites.
Your surgeon will see you in the outpatient clinic 4 to 6 weeks after surgery, and we will take measurements of your arm to monitor any change in size in the future.
Support and more information
Resource number: 5351/VER1
Last reviewed: February 2023
Next review: February 2026
