Immediate breast reconstruction and lymphedema incidence

Background:: As breast cancer survivorship increases, more women are being affected by treatment sequelae, including lymphedema. The purpose of this study was to evaluate lymphedema incidence among immediate breast reconstruction patients and determine what factors are associated with lymphedema, including reconstruction method. Methods:: The authors reviewed the outcomes of all consecutive patients who underwent immediate postmastectomy breast reconstruction at their institution between 2001 and 2006. Patient, treatment, and outcome characteristics were compared among reconstruction types: expander and implant, latissimus dorsi myocutaneous flap and implant, and autologous flap alone. Regression models were used to determine whether patient and treatment characteristics were associated with lymphedema development. Results:: This study included 1117 patients (1499 breasts), with a mean follow-up of 56 months. Axillary interventions (p < 0.001), high numbers of positive lymph nodes (p = 0.004), postoperative radiation therapy (p = 0.007), and body mass index of 25 kg/m or greater (p = 0.010) were strong predictors of increased lymphedema incidence. After excluding prophylactic mastectomy and reconstruction group changes, the authors found that the mean lymphedema incidence was 4.0 percent (of 1013 breasts). Reconstruction type had no significant effect on incidence of or time to lymphedema, and no interaction was found between axillary intervention and reconstruction type (p = 0.799). Conclusions:: The incidence of lymphedema after immediate reconstruction was associated with high body mass index, axillary interventions, and high numbers of positive lymph nodes. The reconstructive method did not appear to affect lymphedema incidence or timing.