Preventing Lymphoedema After Breast Cancer Surgery
LYMPHA is a microsurgical technique performed during lymph node surgery to reduce the risk of lymphoedema. Mr Ghosh plans and leads it as part of your cancer surgery at The London Clinic, working alongside a microvascular surgeon, so your oncological treatment and long-term wellbeing are considered together from the start.
- Reduces lymphoedema risk from 20-25% to approximately 4-8%
- Performed at the same time as your cancer surgery
- Consultant-led care from a specialist oncoplastic surgeon
- Available through NHS and private pathways
Find the Information You Need
Use the links below to go straight to the topic that matters most to you. Each section covers a different part of the lymphodema prevention pathway.
What Is Lymphoedema and Why Does Prevention Matter?
Lymphoedema is persistent swelling, most often in the arm, that can develop after breast cancer surgery when lymph nodes are removed or damaged. It affects approximately 1 in 5 women who have axillary lymph node clearance, and it can appear weeks, months, or even years after treatment.
Once lymphoedema develops, it cannot be cured. It can be managed with compression garments, manual lymphatic drainage, and physiotherapy, but these treatments are lifelong. The condition can cause discomfort, restricted movement, recurring infections such as cellulitis, and a significant impact on daily life and confidence.
This is why prevention at the time of surgery matters. If the lymphatic drainage pathways from the arm can be preserved or rerouted during the operation itself, the risk of lymphoedema developing afterwards drops substantially. LYMPHA is the microsurgical technique that makes this possible. For a detailed guide to what lymphoedema involves and how it is managed, read our full article on lymphoedema after breast surgery.
How Does the LYMPHA Technique Prevent Lymphoedema?
LYMPHA stands for Lymphatic Microsurgical Preventive Healing Approach. It is a microsurgical procedure performed at the same time as axillary lymph node surgery to protect the lymphatic drainage of the arm.
During axillary clearance, the lymph nodes that may contain cancer are removed. Some of these nodes also drain lymph fluid from the arm. When they are removed, the drainage pathway is disrupted, which is what causes lymphoedema to develop over time.
During LYMPHA, Mr Ghosh uses blue dye or fluorescent imaging (indocyanine green) to identify the specific lymphatic channels that drain the arm. These channels are then connected to a small branch of the axillary vein using microsurgical sutures. This creates a new route for lymph fluid to flow back into the bloodstream, bypassing the removed nodes.
Published research from the group led by Professor Francesco Boccardo, who developed the LYMPHA technique, shows that it reduces the incidence of lymphoedema from approximately 20-25% to 4-8% in patients who would otherwise be at high risk. The procedure adds approximately 30 to 60 minutes to the overall operation time and does not require a separate incision.
LYMPHA does not guarantee that lymphoedema will never develop. It significantly reduces the risk, but no surgical technique can remove that risk entirely. Mr Ghosh will explain the realistic expectations during your consultation, based on your individual treatment plan.
Who Can Benefit from LYMPHA?
LYMPHA is most relevant for patients whose breast cancer treatment involves the removal of multiple lymph nodes from the axilla. It is planned in advance and performed during the same operation, so the decision to include it needs to be made before your surgery takes place.
When LYMPHA Is Most Often Discussed
You are having axillary lymph node clearance (sometimes called axillary node dissection) as part of your cancer treatment. This involves removing a larger number of lymph nodes and carries the highest risk of lymphoedema.
You are having a mastectomy combined with axillary clearance, where breast reconstruction is also being planned. In this situation, the cancer removal, reconstruction, and lymphoedema prevention can all be coordinated within a single surgical plan.
You are considered at higher risk of lymphoedema because post-operative radiotherapy to the axillary area is likely. Radiotherapy to the axilla can increase the risk of lymphoedema beyond surgery alone, and LYMPHA may offer an added layer of protection.
When LYMPHA May Not Be Suitable
Patients who are having a sentinel lymph node biopsy alone, where only one or two nodes are removed, generally have a lower risk of lymphoedema (approximately 5%). LYMPHA is not routinely recommended in these cases, though it can be discussed if other risk factors are present.
If your lymph node surgery has already been completed, LYMPHA cannot be performed retrospectively, because it needs to be done at the time of node removal. For patients who have already developed lymphoedema, other microsurgical treatments such as lymphovenous anastomosis (LVA) or vascularised lymph node transfer may be options. Mr Ghosh can advise on what is appropriate during a consultation.
Book a Consultation
If you are facing lymph node surgery and want to understand whether LYMPHA could reduce your risk of lymphoedema, we can discuss this during your consultation.
A member of the team will be in touch to arrange your appointment with Mr Ghosh at our Harley Street clinic. By submitting the form at the bottom of the page, you agree to be contacted regarding your enquiry.
What Happens from Consultation to Recovery?
Step 1: Consultation and Surgical Planning
During your consultation, Mr Ghosh will review your diagnosis, imaging results, and planned cancer treatment. If axillary clearance is part of your surgical plan, he will explain whether LYMPHA is appropriate for your situation and what it involves. You will have time to ask questions and there is no pressure to decide immediately.
Step 2: Multidisciplinary Team Discussion
Your case is reviewed by a multidisciplinary team (MDT) that includes oncologists, radiologists, breast care nurses, and pathologists. The decision about LYMPHA is made within this wider treatment plan, so it fits with your overall care pathway.
Step 3: Surgery Day
LYMPHA is performed during the same operation as your axillary clearance and, where applicable, your mastectomy and reconstruction. It is a team effort. Mr Ghosh identifies, isolates and prepares the veins and lymphatic vessels, and a microvascular surgeon joins them together. There is no separate procedure and no additional incision. This microsurgical element adds approximately 30 to 60 minutes to the total surgery time.
Step 4: Recovery and Early Aftercare
Your recovery follows the same pathway as your cancer surgery. You will receive specific guidance on wound care, arm movement, and when to resume daily activities. Most patients are seen for a follow-up within one to two weeks of surgery.
Step 5: Long-Term Monitoring
Lymphoedema can develop months or years after surgery, even with LYMPHA. Mr Ghosh and the breast care team will monitor you at follow-up appointments. You will also be advised on the practical steps you can take to protect your arm long-term.
Quick-reference strip:
- Additional procedure time: 30-60 minutes
- Hospital stay: as determined by your cancer surgery
- Follow-up: 1-2 weeks post-surgery
- Long-term monitoring: ongoing
What Sets Our Lymphoedema Prevention Service Apart
Cancer Surgery and LYMPHA in One Coordinated Operation
Mr Ghosh plans and leads your care, working as one team with a microvascular surgeon. He identifies, isolates and prepares the tiny veins and lymphatic vessels, and the microvascular surgeon joins them. Your cancer surgery and LYMPHA happen in one operation, so there is no separate procedure and no referral elsewhere.
Dual European Board Certification
Mr Ghosh holds the Fellowship of the European Board of Surgery (FEBS) in both breast surgery and surgical oncology. This is a distinctive qualification that reflects formal, examination-based assessment in cancer management and surgical technique, held by a small number of breast surgeons in the UK.
Microsurgical Precision
LYMPHA joins lymphatic vessels under 1mm wide to a branch of the axillary vein, which takes microsurgical skill. Mr Ghosh identifies, isolates and prepares these vessels, and a microvascular surgeon performs the join, known as the anastomosis. His experience in DIEP flap and lymphatic surgery makes him well placed to lead this part.
Planned Into Your Care from the Start
LYMPHA is not an afterthought or an add-on. It is considered as part of your surgical plan from the first consultation, alongside decisions about your cancer surgery, reconstruction options, and post-operative treatment.
What Else Can You Do to Reduce Your Risk?
Whether or not you have LYMPHA, there are practical steps that can help protect your arm after lymph node surgery. Current guidance from Cancer Research UK and Macmillan Cancer Support recommends the following.
Staying active and maintaining a healthy weight are two of the most effective ways to support your lymphatic system after surgery. Gentle exercise, built up gradually with guidance from your physiotherapy team, helps keep lymph fluid moving. Your breast care nurse will advise you on when to start and what is safe for your stage of recovery.
Protecting the skin on your affected arm reduces the risk of infections that can trigger or worsen lymphoedema. Use moisturiser regularly, treat any cuts or insect bites promptly, and wear gloves for gardening or tasks where your skin might be broken. Where possible, have blood tests, injections, and blood pressure readings taken from your unaffected arm.
If you notice any swelling, heaviness, tightness, or changes in the fit of clothing or jewellery on your affected side, contact your breast care team promptly. Lymphoedema is easier to manage when it is identified early.
For more on what axillary clearance and lymph node removal involves, including recovery and common concerns, read our detailed guide.
Rated 4.96 out of 5 from 98 Verified Patient Reviews on Doctify
Mr Ghosh provides exceptional medical care, fostering trust and personalised attention that reassures both patients and their families alike.
Mr Debashis Ghosh is a Consultant Oncoplastic Breast Surgeon at The London Clinic on Harley Street. He holds dual Fellowship of the European Board of Surgery (FEBS) in breast surgery and surgical oncology, and he currently serves as Divisional Director of Surgery at The London Clinic. Within the NHS, he is Clinical Director for Breast Services at the NCL Cancer Alliance.
His practice spans breast cancer surgery, oncoplastic reconstruction, and microsurgical techniques including DIEP flap reconstruction. He also provides LYMPHA, preparing the veins and lymphatics for a microvascular surgeon to join, to reduce the risk of lymphoedema.
He also serves as a NICE expert adviser in breast surgery. Mr Ghosh’s published research includes work on intraoperative radiotherapy, sentinel node assessment, fluorescence-guided surgery, and the LYMPHA technique for lymphoedema prevention.
Patients describe Mr Ghosh as calm, thorough, and honest. He takes time to explain every option, answers questions without rushing, and supports patients through what can be one of the most significant decisions of their lives. Whether your surgery is straightforward or complex, Mr Ghosh and the team deliver specialist care with a personal approach at every stage.
- Dual European Board certified (FEBS) in breast surgery and surgical oncology
- NICE expert adviser in breast surgery
- Divisional Director of Surgery, The London Clinic
- Board Certification in Cosmetic Breast Surgery through RCS England
Where to Find Us in London
Local London Clinics
Breast reconstruction consultations and surgery take place at leading London hospitals with fast access to imaging, theatres and specialist nursing.
Frequently Asked Questions About Lymphoedema Prevention
We have answered the questions patients ask most often. If your question is not covered here, please get in touch and we will be happy to help.
Does LYMPHA completely prevent lymphoedema?
No. LYMPHA significantly reduces the risk but does not eliminate it entirely. Published research shows that the incidence of lymphoedema drops from approximately 20-25% to 4-8% in patients who have LYMPHA performed at the time of axillary clearance. Some patients may still develop mild lymphoedema, and long-term monitoring remains important. Mr Ghosh will set honest expectations during your consultation based on your specific treatment plan.
Is LYMPHA available on the NHS?
LYMPHA is available at a small number of NHS centres in the UK. Mr Ghosh offers LYMPHA, working with a microvascular surgeon, within his NHS practice at the Royal Free Hospital for eligible patients, as well as privately at The London Clinic. Availability through the NHS depends on your local breast unit and referral pathway. If you are being treated elsewhere and want to discuss LYMPHA, you can request a referral or self-refer for a private consultation.
What if I have already had my lymph node surgery without LYMPHA?
LYMPHA can only be performed at the time of lymph node removal, so it cannot be done retrospectively. If you have already had axillary surgery and are experiencing or concerned about lymphoedema, other options may be available, including lymphovenous anastomosis (LVA) and conservative management with a specialist lymphoedema physiotherapist. Mr Ghosh can advise on the most appropriate next step for your situation.
How do I know if I am at high risk of lymphoedema?
The main risk factors are the number of lymph nodes removed, whether you receive radiotherapy to the axillary area, and your body mass index. Patients who have axillary lymph node clearance (removal of multiple nodes) carry the highest risk, estimated at 20-25%. Sentinel lymph node biopsy alone carries a lower risk of approximately 5%. Your breast surgeon and multidisciplinary team will assess your individual risk as part of your treatment planning.
Does LYMPHA add risk to my cancer surgery?
LYMPHA does not require a separate incision and the published evidence shows no significant increase in complications compared with axillary surgery alone. The procedure adds approximately 30 to 60 minutes to the overall operation time. The most common additional element is the use of blue dye or indocyanine green (ICG) to identify the arm’s lymphatic channels, which carries a small risk of allergic reaction. Mr Ghosh will discuss all risks during your consultation.
Do I need a GP referral to see Mr Ghosh?
No. You can self-refer for a private consultation. Referrals are also accepted from GPs, hospital consultants, and other specialists. For NHS care at the Royal Free Hospital, a referral from your GP or breast unit is usually required.
Still have questions? Let’s discuss!
Book a Consultation to Discuss Lymphoedema Prevention
If you are planning breast cancer surgery that involves lymph node removal, ask about LYMPHA during your consultation. Mr Ghosh will explain whether it is appropriate for your situation and what it involves, with no pressure and no obligation. A member of the team will be in touch to arrange your appointment.
By submitting the form below, you agree to be contacted regarding your enquiry.