Restoring Lymph Flow

Fortunately, the days when breast cancer often ended fatally are long behind us. "Breast cancer is now very treatable in most cases," says Elisabeth Kappos, senior physician for reconstructive surgery at the University Hospital Basel. "As a result, the focus has shifted," she continues. "It's no longer just about survival, but increasingly about the quality of life after treatment."

Tissue swelling in the Arm

As a member of the Breast Center at the University Hospital Basel, Kappos has been in contact with breast cancer survivors for years. She knows that breast cancer-related lymphedema is a major problem. These are tissue swellings in the arms that occur when the lymphatic pathways in the armpits are damaged after surgery or radiation therapy, causing fluid to accumulate.

The swelling is often very uncomfortable. It limits shoulder mobility and can lead to infections. Since about one in five patients suffers from it, breast cancer-related lymphedema is "one of the most underestimated and burdensome side effects of treatment," says Kappos.

Until recently, patients only had options like lymphatic drainage and compression sleeves, which, although they alleviate symptoms, do not cure the lymphedema. It is only in the last decade that new microsurgical procedures have emerged, which allow connections between lymphatic vessels to be created, or intact lymph nodes from other areas of the body to be transplanted into the damaged region.

Great Manual Skill

Kappos learned these techniques through specialized training at the University of Toronto in Canada and the University Hospital of Brussels in Belgium. They require great manual dexterity and a delicate touch for the intricate and vulnerable structures in the body. Kappos didn't realize she possessed these talents at the start of her medical studies.

But during her practical year, with a scholarship, she worked at two prestigious hospitals in the U.S. At Duke Medical Center and Mount Sinai Medical School in New York, she helped as part of the transplant team to transplant organs. "That was a very inspiring time for me, and I was greatly supported," says Kappos. She found working in the operating room "motivating and very rewarding, because we often solve problems directly, and our results are immediately visible."

Back in Switzerland, Kappos first worked in general surgery before specializing in hand surgery and later reconstructive surgery—finding her calling in the "delicate and bloodless" field of microsurgery. "I give my maximum effort, but not because I have to, but because I am allowed to: I feel privileged to be able to do this work." She finds it "uplifting" that she has succeeded as a woman in the traditionally male-dominated field of surgery—and hopes she can inspire "the next generation of young female doctors."

Proven Benefit Still Needed

The surgeries to restore lymphatic vessels are not listed in the catalog of insured services. Before each procedure, a request for cost approval must be submitted, which is often accepted but sometimes rejected. This is because there are currently no studies that definitively prove the benefit of microsurgical procedures for breast cancer-related lymphedema.

That is exactly the goal of the clinical study Kappos has developed in collaboration with breast cancer survivors. Over the next few years, more than 20 hospitals in Switzerland, Europe, South America, and the U.S. are expected to enroll a total of 280 patients in the study.

Great Relevance Thanks to Patient Involvement

Kappos believes the study is more relevant because breast cancer survivors were involved in its planning. They not only reflected on what is reasonable for patients, such as how often they can be called back to the hospital for follow-up care, but also convinced her to focus on quality of life as the most important comparison point (primary endpoint of the study). "At first, I wanted to focus on arm volume because it can be measured clearly and objectively," says Kappos. "But I was persuaded otherwise, because for the patients, it's not about how many centimeters the arm circumference has reduced. What matters is whether they can move their arm better and experience less discomfort."