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Abstract

Background/Objectives: Despite the popularity of vascularized lymph node transfers (VLNTs) for treatment of breast cancer-related lymphedema (BCRL), the comparative effectiveness of VLNT placement locations is unknown. In this meta-analysis, we examined the impact of VLNT recipient site (proximal vs. distal vs. dual) and adjunct surgical techniques, including scar release, supercharging, and intervention timing on patient outcomes. Methods: PRISMA-guided search of PubMed, MEDLINE, and Embase (January 2015–March 2025). Patient outcomes including limb circumference/volume reduction, cellulitis frequency, compression garment discontinuation, and patient satisfaction were analyzed. Subgroup analyses assessed node placement, scar release, supercharging, and timing. Results: A total of 1440 patients were analyzed (proximal 63.8%; distal 29.2%; dual 7.0%). No significant differences in mean volume/circumference reductions, patient satisfaction rates, and compression garment discontinuation were observed amongst placement strategies (p > 0.30). Adjunct scar release (65%) was associated with significantly greater patient satisfaction (p = 0.04) and showed trends toward improved volume reduction and compression discontinuation. Earlier intervention (<5 years from diagnosis) showed improved volume reduction, patient satisfaction, and compression discontinuation. Longitudinal analysis revealed dual placement maintained superiority throughout a 12-month follow-up. Conclusions: VLNT is an effective treatment for BCRL regardless of placement location, with all strategies demonstrating substantial clinical improvements. While dual placement showed numerically superior outcomes across all measures, differences did not reach statistical significance due to limited number of studies. Adjunct scar release significantly improves patient satisfaction, and earlier intervention may optimize outcomes. These findings suggest that recipient site selection may be guided by technical factors, vessel availability, and patient preference rather than efficacy differences.