In honor of Lymphedema Awareness Month, the March Research Roundtable featured Dr. Philip Brazio, Co-Director of the LE&RN Comprehensive Lymphedema Center of Excellence at Cedars-Sinai Medical Center in Los Angeles, CA, in conversation with Dr. Karen Herbst on advances in lymphedema treatment and the expanding role of surgical and comprehensive care.
Dr. Brazio began by clarifying what lymphedema is—and isn’t. Because blood vessels and cells naturally allow small amounts of fluid to leak into surrounding tissues, the lymphatic system acts like a “sump pump,” clearing that fluid, transporting immune cells, and returning lymph to the bloodstream. Lymphedema develops when this system is damaged or overwhelmed. This can happen after cancer surgery or radiation, injury, congenital underdevelopment, or long-standing venous disease, which leads to swelling, discomfort, and increased infection risk.
A key takeaway was the importance of objective imaging. Lymphedema should not be a diagnosis of exclusion. Tools such as MR lymphography, ICG fluorescence imaging, and lymphoscintigraphy help confirm lymphatic dysfunction and guide surgical planning. Dr. Brazio emphasized that a venous duplex ultrasound is also critical, especially for leg swelling, since venous insufficiency commonly mimics or coexists with lymphedema. Accurate diagnosis ensures patients receive the right treatment pathway.
Two broad surgical approaches were outlined: debulking and physiologic reconstruction. Over time, stagnant lymph fluid can trigger inflammation that leads to fibrofatty tissue buildup, creating persistent limb enlargement. Liposuction can effectively remove this tissue but does not restore lymph flow and requires continued compression. Physiologic procedures aim to improve drainage itself. Lymphovenous bypass (LVB) reroutes lymphatic channels into low-pressure veins, while vascularized lymph node transfer (VLNT) transplants healthy lymph nodes to promote lymph absorption and regeneration. Imaging findings determine candidacy, and outcomes improve when procedures are carefully matched to each patient.
The discussion also highlighted encouraging real-world results with GLP-1 and dual GLP-1/GIP medications, with clinicians observing meaningful reductions in inflammation and swelling in some patients. Post-operative care remains highly individualized, coordinated closely with certified lymphedema therapists. Compression strategies vary depending on the procedure and patient needs, reinforcing that long-term management is a team effort.
In closing, Dr. Brazio expressed optimism about two areas: expanding insurance coverage and legislative progress, and continued advances in imaging and surgical precision to improve outcomes. While not every surgery yields the desired result, the field is rapidly evolving. For patients seeking expert care, viewers were encouraged to consult the LE&RN Centers of Excellence directory at lymphaticnetwork.org to locate vetted, multidisciplinary programs.
Lymphedema Awareness Month shines a spotlight on progress, but the commitment to improving care continues year-round at www.lymphapress.com.
This Roundtable was originally recorded live on March 2, 2026. The views and opinions expressed in this program are those of the speakers and do not necessarily reflect the opinions or positions of Lympha Press. The content is for educational purposes only and not intended as medical advice.
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