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Reduced Incidence of Breast Cancer–Related Lymphedema following Mastectomy and Breast Reconstruction versus Mastectomy Alone

Card, Annika M.D.; Crosby, Melissa A. M.D.; Liu, Jun M.D., M.S.; Lindstrom, Wayne A. M.D.; Lucci, Anthony M.D.; Chang, David W. M.D.

Plastic and Reconstructive Surgery: December 2012 - Volume 130 - Issue 6 - p 1169–1178
doi: 10.1097/PRS.0b013e31826d0faa
Breast: Original Articles
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Background: As breast cancer survivorship has increased, so has an awareness of the morbidities associated with its treatment. The incidence of breast cancer–related lymphedema has been reported to be 8 to 30 percent in all breast cancer survivors. To determine whether breast cancer reconstruction has an impact on the incidence of breast cancer–related lymphedema, the authors compared its incidence in patients who underwent mastectomy with reconstruction versus mastectomy alone.

Methods: All patients who underwent mastectomy, with or without immediate breast reconstruction, between 2001 and 2006, were identified through a search of prospective institutional databases. To reduce variation caused by known predictive factors, the individuals were cross-matched for age, axillary intervention, and postoperative axillary irradiation. The incidence of lymphedema was based on the presence of arm edema that lasted more than 6 months and was documented clinically.

Results: Of the 574 cross-matched patients included in the study, 78 (6.8 percent) developed lymphedema (21 with reconstructed breasts and 57 with unreconstructed breasts). Patients who did not undergo reconstruction were significantly more likely to develop breast cancer–related lymphedema (9.9 percent versus 3.7 percent; p < 0.001). Postoperative axillary radiation therapy (p < 0.001), one or more positive lymph nodes (p = 0.010), and body mass index of 25 or greater (p = 0.021) were also associated with an increased incidence of lymphedema. Reconstruction patients developed lymphedema significantly later than nonreconstruction patients (p < 0.001).

Conclusion: Patients who undergo breast reconstruction have a lower incidence and a delay in onset of breast cancer–related lymphedema compared with patients who undergo mastectomy alone.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Houston, Texas

From the Department of Plastic Surgery and the Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center.

Received for publication April 19, 2012; accepted June 14, 2012.

Presented at the 91st Annual Meeting of the American Association of Plastic Surgeons, in San Francisco, California, April 15 through 17, 2012.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Melissa A. Crosby, M.D.; Department of Plastic Surgery, 1400 Pressler, FCT19.5000, Unit 1448, P.O. Box 301402, Houston, Texas 77230-1402, macrosby@mdanderson.org

©2012American Society of Plastic Surgeons