The VOICE of UPMC Shadyside Winter 2021–2022

A New Era in Lymphedema Care

A commitment to “do it better than yesterday” has led Carolyn De La Cruz, MD, to introduce innovative techniques in plastic surgery

“I have always believed that things can be made better,” says Carolyn De La Cruz, MD, UPMC Shadyside’s new chief of plastic surgery. “That’s always been my goal. Whatever I’m doing, I think it’s important to put in the effort and passion to do it better than yesterday.”

This commitment to challenging the status quo at first led Dr. De La Cruz to introduce innovative microsurgical techniques to breast reconstruction — pushing the boundaries to help more patients with greater precision and safety. Using specialized operating microscopes, she and other reconstructive microsurgeons can repair intricate structures such as blood vessels and nerves less than a tenth of an inch in diameter.

Always eager to explore new technology, Dr. De La Cruz did specialized training in the emerging field of microsurgery at MD Anderson Cancer Center in Houston in the early 2000s. In 2004, the Philadelphia native was recruited by UPMC and the University of Pittsburgh to introduce microsurgery for breast reconstruction patients here. Since those early days, the therapy has become very popular for post-cancer reconstructions.

Then about ten years ago, Dr. De La Cruz discovered her “second passion.” She again saw a new opportunity to improve the quality of life for more patients — by broadening the existing scope of care for lymphedema.

Lymphedema is a condition in which swelling (edema) occurs because of impaired circulation of lymph fluid in the body, typically in the arms or legs. The problem is not uncommon after the removal of or damage to lymph nodes as a part of cancer treatment and other illnesses. And, because lymph mainly contains bacteriafighting white blood cells, this swelling is more than a cosmetic problem. Lymphedema can lead to serious complications such as bacterial infection.

“Lymphedema turns out to be a major problem in just about every scope of patient care,” Dr. De La Cruz observes. “But lymphedema patients have been poorly understood because, medically speaking, there’s not a lot of information about it. Until about a decade ago, there seemed to be no surgical way of treating lymphedema.”

“But in 2012,” Dr. De La Cruz remembers, “I became aware that microsurgeons in Europe and Asia were starting to use new, more advanced techniques to diagnose and treat lymphedema patients. And so I traveled to one of the major microsurgery centers, in Taiwan, and I realized that there was a real sort of renaissance happening with lymphedema care.”

She was amazed to see that this new technology offered microsurgeons the ability to use “really tiny, tiny needles” to bypass and reroute damaged lymphatic vessels, and even to replace lymph nodes by transferring the patient’s own nodes from one part of the body to another.

She returned home filled with excitement and challenged by the opportunity to bring this renaissance to Pittsburgh.

“Building on the foundations of the existing medical lymphedema centers at UPMC and working especially with Atilla Soran, MD, MPH, FACS, who directs the medical lymphedema program at the University of Pittsburgh, we set out to expand lymphedema care to include surgical therapies,” she says.

After further training in Japan, China, and Europe, and at major medical centers in the United States, Dr. De La Cruz performed Pittsburgh’s first lymphedema microsurgical procedure in 2014, at UPMC Magee. In 2020, the program moved to UPMC Shadyside, making the hospital one of the few in the country to offer such advanced therapies.

“Lots of patients get lymphedema,” Dr. De La Cruz explains. “It’s not just the oncology patients. And at Shadyside, we have the ability to tap into all the specialties and disciplines this remarkable hospital offers, such as vascular and orthopaedic. Our hope is to fill a wider and wider range of unmet needs.”

“To me, the heart of being a doctor and a surgeon is to be able to offer the best possible care to every patient. Whatever boundaries I need to push to do that better, that’s what I want to do.”
- Carolyn De La Cruz, MD

In addition to her surgical innovations, the iconoclastic surgeon decided that to be a complete care provider for her patients, she had to become a certified lymphedema therapist.

“A large part of lymphedema care is or can be adjuvant therapies, compressive wrappings and medical treatments that are not necessarily surgical,” she points out. “I wanted to understand exactly what that means and what has been done traditionally. If I’m ordering a therapy, I need to know how it works. If it’s not working, I need to know why. And that had not been part of my training.”

And so Dr. De La Cruz — who has won teaching awards for training plastic surgery residents and published numerous scientific papers — registered for the intensive nine-day certification course.

Immediately, the course director called her. “Surgeons don’t do this,” the director said.

“Well, I do,” Dr. De La Cruz remembers with her quick and throaty laugh. “So I showed up and took the course — and wound up teaching the session on surgical therapies!

“To me,” she says, “the heart of being a doctor and a surgeon is to be able to offer the best possible care to every patient. Whatever boundaries I need to push to do that better, that’s what I want to do.”