Introduction
Breast-cancer related lymphedema is a high-morbidity complication that is commonly seen in women seeking breast reconstruction. Risk factors including lymphatic disruption, radiation, and body mass index (BMI) are well accepted. Limited data suggests immediate breast reconstruction may be protective against lymphedema. We seek to better define the relationship between timing and method of breast reconstruction and risk of lymphedema development.
Methods
After institutional board approval (HUM00257045), patients who received breast reconstruction consultation at a single academic institution within the last 5 years were retrospectively reviewed. Demographics, oncological, reconstructive, and lymphedema disease characteristics were collected. All data was collected using Microsoft Excel and statistical analyses were performed using R-Studio version 4.3.2. Lymphedema and non-lymphedema cohort characteristics were compared using independent t-test and chi-squared test of independence. Multivariate logistic regressions were performed.
Results
761 patients met inclusion criteria, 213 (30.0%) of whom experienced diagnosed upper extremity lymphedema at any point after breast cancer treatment. Compared to non-lymphedema patients, lymphedema patients were more likely to have higher BMI (p=0.039), have received radiation treatment (p<0.001), and have a delayed reconstruction (p=0.027). When controlling for measures of health disparities, age, BMI, lymphatic intervention, radiation, and receiving any breast reconstruction, only radiation and BMI were predictive of developing lymphedema in all patients (p<0.001 and p=0.011 respectively). In patients who decided to undergo breast reconstruction, radiation remained the only predictor of developing lymphedema at any time point (p=0.001) when controlling for autologous versus implant reconstruction, delayed versus immediate reconstruction, lymphatic intervention, time from mastectomy to reconstruction, tissue expander use, radiation with tissue expander in place, and BMI. Interestingly, we did not find any significant predictors of developing lymphedema after reconstruction when controlling for the same variables, including radiation (p = 1.000).
Conclusions
Within our patient cohort, reconstruction type and timing does not significantly impact lymphedema incidence. These results may inform patient-physician decision making when consulting for reconstruction. Future studies should focus on utilizing quantitative lymphedema data, including lymphedema staging and L-dex scores, to better define lymphedema severity in this population.
Tables and Figures
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