How a Humber River Hospital Plastic Surgeon is Using Supermicrosurgical Techniques in Revolutionary Lymphedema Program

May 16, 2018

Dr. Thomas Constantine, a plastic surgeon who works with cancer patients and leads Humber River Hospital’s breast reconstruction program, is among the first physicians in North America to apply state-of-the-art technology and his advanced training in supermicrosurgery to treat lymphedema.

Dr. Thomas Constantine

A lymphedema mapping using the advanced portable ICG technology available at Humber.

Lymphedema is more and more diagnosed and recognized as a concern for cancer and trauma patients. Chemotherapy, radiation, cancer surgery, and trauma can all play a role in damaging the lymphatic system, which can manifest with limb swelling, deformity, pain, skin changes, infection, and decrease in quality of life, well beyond the initial cancer or injury.

“It is not always enough to reconstruct the breast,” says Dr. Constantine, “We also have to consider the lymphatic system and offer comprehensive treatment options to our patients.”

To do this, Dr. Constantine is applying the advanced training he underwent in Taiwan and Japan, where much of the expertise in this field originated. These techniques are revolutionary, but it is impossible to reliably perform them without the right equipment, which includes a powerful microscope, special supermicrosurgical instruments, and ICG technology used for imaging.

Humber River Hospital is the first hospital in Canada to have the brand new advanced portable ICG technology for clinical use to facilitate these lymphatic supermicrosurgeries. The technology allows Dr. Constantine to further diagnose the extent of disease and its pattern, and evaluate a potential surgical plan individualized to each unique patient. He also uses the technology to track outcomes and the effect of treatment.

The technology is portable, which enables him to use the imaging equipment not only in the Operating Room, but also in the clinic, with the patients fully awake and comfortable.


“It is not always enough to reconstruct the breast,” says Dr. Constantine, “We also have to consider the lymphatic system and offer comprehensive treatment options to our patients.”

“It is currently impossible to do these surgeries reliably without our state-of-the-art ICG technology and equipment,” explained Dr. Constantine, “We have the expertise and we have the technical equipment. Hospitals need both to provide these surgeries. We are proud to be among the first hospitals in North America to offer comprehensive reconstruction and surgical lymphedema treatment.”

A lot of work goes into each lymphedema surgery. Dr. Constantine works with his hands to manually repair damaged areas in the lymphatic network. The lymphatic network is like a honeycomb, and Dr. Constantine needs to use the most advanced tools available to him to connect a lymphatic (less than a fraction of a millimeter in diameter) to a vein. It is no surprise that each surgery can take several hours, and needs to be meticulously planned.

“There was a long time when we were limited by our equipment and access to care,” Dr. Constantine says, “Now the problem of lymphedema is increasingly diagnosed and patients are being seen in consultation to explore individualized options, above and beyond their cancer treatment and reconstructions. We can use new techniques that were never available to our patients before.”

Our Thanks

The ICG Technology is currently being used at Humber River Hospital in breast reconstruction, and in the new Lymphedema Program. Purchasing this technology was made possible thanks to a generous donation from the Paul B. Helliwell Foundation. Thank you for helping reinvent patient care!


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We wrote about this program again in March 2020. You can read that post here.