Variable Anatomy of the Lateral Upper Arm Lymphatic Channel: A Potential Anatomic Risk Factor for the Development of Breast Cancer Related Lymphedema

Authors

Melisa D. Granoff, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Jaime Pardo, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Kathy Shillue, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Aaron Fleishman, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Paige Teller, Division of Surgical Oncology, Maine Medical Center, Portland, ME, USA.Follow
Bernard T. Lee, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Ted James, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Dhruv Singhal, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Document Type

Article

Publication Date

1-24-2023

Institution/Department

Oncology; Surgery

Journal Title

Plastic and Reconstructive Surgery

Abstract

BACKGROUND: The lateral upper arm channel is an accessory lymphatic pathway that drains the upper extremity via the deltopectoral groove and supraclavicular nodes, thereby bypassing the axilla. Its variable connectivity to the forearm has not been studied in vivo. METHODS: Indocyanine green (ICG) lymphography was performed pre-operatively to map the superficial and functional arm lymphatics in breast cancer patients without clinical or objective evidence of lymphedema. A retrospective review was performed to extract demographic, ICG imaging, and surgical data. RESULTS: Sixty patients underwent ICG lymphography prior to axillary lymph node dissection between June 2019 and October 2020. In 59%, the lateral upper arm lymphatic channel was contiguous with the forearm (long bundle). In 38%, the lateral upper arm lymphatic channel was present but not contiguous with the forearm (short bundle). In 3%, the lateral upper arm pathway was entirely absent. Seven patients developed at least one sign of lymphedema during post-operative surveillance, of which 71% demonstrated the short bundle variant. CONCLUSIONS: While the lateral upper arm pathway is most often present, its connections to the forearm are frequently absent (short bundle) and, in this pilot report, appears to represent a potential risk factor for the development of lymphedema.

Recommended Citation

Granoff MD, Pardo J, Shillue K, et al. Variable Anatomy of the Lateral Upper Arm Lymphatic Channel: A Potential Anatomic Risk Factor for the Development of Breast Cancer Related Lymphedema [published online ahead of print, 2023 Jan 24]. Plast Reconstr Surg. 2023;10.1097/PRS.0000000000010245. doi:10.1097/PRS.0000000000010245