For Coordinating Clinicians
Lymphedema surgery coordination
A practical guide for oncologists, breast and vascular surgeons, physiatrists, and certified lymphedema therapists coordinating care for microsurgical evaluation — lymphaticovenous anastomosis, vascularised lymph node transfer, or reduction surgery — at the flagship lymphedema consultancy, St. Luke’s Medical Center, BGC.
When It Helps to Coordinate
Patients who may benefit
I
Persistent limb swelling
Swelling that hasn’t adequately responded to a proper trial of complete decongestive therapy and compression — typically 3–6 months of consistent, well-fitted conservative management.
II
Recurrent cellulitis or lymphangitis
Repeated skin infection referable to the affected limb is both a consequence of impaired drainage and a reason, on its own, to evaluate for a surgical option that may reduce recurrence.
III
Functional limitation
Heaviness, pain, or restricted use of the limb that affects activities of daily living, work, or garment fit — independent of the measured volume difference.
IV
Immediate lymphatic reconstruction at index surgery
Node-positive breast, gynecologic, or urologic cancer patients undergoing axillary, pelvic, or inguinal lymphadenectomy are good candidates for pre-operative coordination toward prophylactic lymphaticovenous anastomosis, performed at the time of the index cancer surgery alongside the operating surgeon.
V
Diagnostic uncertainty
Where lipedema, venous disease, or another cause of limb swelling hasn’t been ruled out, or where staging would change management, coordinating imaging — indocyanine green lymphography and high-frequency ultrasound — can clarify the picture even before surgery is on the table.
Staging Guides Selection
Where staging fits
Coordination doesn’t require staging to already be established — that workup happens here — but a working sense of severity helps triage the visit.
Stage 0–I
Subclinical impairment or reversible, pitting swelling. Best candidates for lymphaticovenous anastomosis, where residual lymphatic function still exists to reroute.
Stage II
Non-pitting swelling with early fibrosis. LVA remains an option where function is preserved; vascularised lymph node transfer is considered where it is not.
Stage III
Established fibrofatty change and skin involvement. Debulking — targeted liposuction, occasionally excisional surgery — is more often indicated, sometimes alongside a physiologic procedure.
If You’re Able to Share
What’s helpful to know
None of this is required — whatever you’re able to share helps, and any gaps get filled in at the visit.
1
Onset, duration, and laterality of the swelling
2
Suspected or confirmed cause — e.g. post-axillary or -pelvic node dissection, post-radiation, primary, or other
3
Conservative management to date and the patient’s response to it
4
Relevant imaging already on hand — ultrasound, lymphoscintigraphy, ICG lymphography, CT or MRI, if available
5
Oncologic status and clearance, where applicable
6
Contact details for the patient, and a direct line back to you for follow-up correspondence
At the First Visit
The initial workup
I
History, and bilateral limb circumference or volumetry to document baseline.
II
Indocyanine green lymphography and high-frequency ultrasound, mapping how the lymphatics are functioning and where they still are.
III
A candid discussion of what surgery can and cannot do — it restores or improves outflow, or reduces fibrofatty bulk; it works alongside ongoing compression and therapy, not instead of it.
IV
If surgery is appropriate, it is performed at St. Luke’s Medical Center, BGC, or Cardinal Santos Medical Center; timing and anaesthesia are decided case by case. You’ll be kept in the loop — findings and a management plan are shared back with the coordinating clinician after the visit.
Presenting on lymphedema surgery in the Philippine context
Outpatient Clinics
Where the consultation happens
Flagship · Lymphedema Surgery Consultancy
St. Luke’s Medical Center — BGC
Suite 1036, Medical Arts Building
Taguig, Metro Manila
By appointment
Taguig, Metro Manila
By appointment
Consultation
Cardinal Santos Medical Center
Suite 176, Medical Arts Building
Wilson St., Greenhills, San Juan
By appointment
Wilson St., Greenhills, San Juan
By appointment
Additional Partner Hospitals
Dr. Cruz also consults at additional partner hospitals across Metro Manila — let us know when coordinating care, and the nearest option for your patient will be arranged.
Patients travelling from outside Metro Manila or from abroad can be scheduled for a concentrated visit — workup and, where appropriate, surgery timed within a single trip. See how care works for patients travelling from a distance.
Reach the Clinic
Getting in touch
Whatever’s easiest works — an email to [email protected], or a call, Viber, or WhatsApp message to the clinic directly, below. Any notes on the case are welcome, but even a short description is plenty to get things started — and we’ll follow up with you after the visit.
Related
Read on
Read on
Lymphedema Surgery
The patient-facing overview — useful to share directly with your patient
All Locations
Full address and directions for every consultation site
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Dr. Pacifico Cruz
Board-certified plastic surgeon — reconstructive microsurgery and aesthetic facial rejuvenation.
Locations
St. Luke's Medical Center, BGC
Cardinal Santos Medical Center
Aesthetic Institute of the Philippines
© 2026 Dr. Pacifico Cruz, MD. Information on this site is for general purposes and does not constitute medical advice.