Despite the concern of mTOR inhibitor-induced lymphedema, there has only been a handful reports on extremity lymphedema related to sirolimus.4, 5, 8, 9, 10Furthermore, the treatment for mTOR inhibitor-induced lymphedema has been focused on cessation of drugs and provide complex decongestive therapy (CDT).1, 11To the best of authors' knowledge, there has been no report and is the first study using the physiologic surgical approach for these patients. Here, MTOR is linked to lymphedema.