Specialist Plastic Surgeon Dr Frank Hsieh is the first in Australia to introduce lymphovascular bypass surgery, a subspeciality in plastic surgery, and has now performed the technique on 20 patients with no reports of lymphoedema.
Lymphoedema is a condition of localised swelling caused by a compromised lymphatic system and is commonly experienced by people with breast cancer following the removal of lymph nodes.
Western Sydney Local Health District, Chief Executive, Graeme Loy said with up to 40 per cent of people who have lymph nodes removed developing lymphoedema, this breakthrough is already changing lives for breast cancer patients.
“This new form of surgery by Dr Frank Hsieh at Westmead Hospital is groundbreaking in preventing women diagnosed with breast cancer, from potentially developing lymphoedema which can be debilitating,” Mr Loy said.
“This is a fantastic breakthrough for breast cancer patients in western Sydney to have access to this potentially life-changing procedure allowing women to live their lives with strength and confidence, post breast cancer surgery.”
Dr Hsieh said the new surgical technique being piloted at Westmead Hospital uses nano technology, where the tip of the instrument is super fine to enter the body.
“It’s finer than one strand of hair, with the magnification able to reach 70 times. The lymph fluids are trapped and just want to get out, so we use the nano technology to re-route it into another system,” Dr Hsieh said.
“The lymphovascular surgery is performed in the same procedure as lymph node clearance and only adds 30 minutes to the operation time.
“This is really the pinnacle of microsurgery. A surgeon has to be proficient in microsurgery first (around 1.5 mm in diameter) then you can challenge the <0.8mm in lymphatic surgery which is called supermicrosugery.”
The first patient to undergo Dr Hsieh’s new surgery in January 2024 was Urhay Hawel who was diagnosed with stage two breast cancer at 27-years-old.
Urhay had a double mastectomy, and three lymph nodes were removed from her right arm. However, as cancer was found in all three lymph nodes, she had to undergo a full clearance which can increase a person’s chances of developing lymphoedema.
“I was extremely distressed hearing this news. This is when I was introduced to Dr Hsieh. He told me he would perform a procedure called anastomosis on a microscopic level; essentially, re-routing my lymphatic channel,” Ms Hawel said.
“This would decrease my chance of developing lymphoedema. I did not have to think twice about this option as my worst fear (second from cancer) was developing lymphoedema, and dealing with the debilitating effects, restrictions, and loss of functionality in my arm.
“This procedure is truly lifechanging. Following my surgery and radiation, I have been actively training at the gym and lifting heavier weights than I did pre-cancer. I have had no pain, restrictions, or issues with my strength.”
The 12-month pilot phase of the procedure at Westmead Hospital has now been completed, with all patients followed up at 3, 6 and 12-months post-operation showing no signs of developing lymphoedema.
Dr Hsieh’s work will be published following his 18-month follow-up appointments with all patients. In the next phase of the pilot, Dr Hsieh will also look at expanding the use of the procedure by training more surgeons in this field of plastic surgery.
A trial of the procedure involving six hospitals in North America (USA & Canada) started in 2013 and is now performed in top units in countries such as the UK, Germany, Japan and India. With few surgeons trained and experienced in the microsurgery, globally, the procedure is still very limited in scale.
