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J Reconstr Microsurg 2024; 40(04): 262-267
DOI: 10.1055/a-2153-2203
Original Article

Immediate Lymphatic Reconstruction in 77 Consecutive Breast Cancer Patients: 2-year Follow-up

Nicole K. Le 
1   Department of Plastic Surgery, University of South Florida, Tampa, Florida
,
Brielle Weinstein
1   Department of Plastic Surgery, University of South Florida, Tampa, Florida
,
Jeegan Parikh
2   Global Communicable Diseases, College of Public Health, University of South Florida, Tampa, Florida
,
Lokesh A. Coomar
3   Department of Surgery, Center for Anatomical Science and Education, Saint Louis University School of Medicine, St. Louis, Missouri
,
D'Arcy Wainwright
1   Department of Plastic Surgery, University of South Florida, Tampa, Florida
,
Langfeier Liu
1   Department of Plastic Surgery, University of South Florida, Tampa, Florida
,
Jamila Mammadova 
1   Department of Plastic Surgery, University of South Florida, Tampa, Florida
,
Tina Tavares
4   Department of Women's Oncology, Breast Program, Moffitt Cancer Center, Tampa, Florida
,
Nicholas J. Panetta
1   Department of Plastic Surgery, University of South Florida, Tampa, Florida
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Abstract

Background Breast cancer-related lymphedema (BCRL) is a cyclical, progressive disease that begins at the time of axillary dissection and worsens in the setting of adjuvant oncologic therapies. The paradigm of lymphedema management in these patients is shifting from therapeutic surgeries and decongestive therapy to preventative surgery with immediate lymphatic reconstruction (ILR).

Methods After institutional review board approval, a prospective database was maintained of all patients undergoing ILR. Patients were excluded if they had preoperative lymphedema or expired during the study period. All ILR were performed by the senior author. A control group was established with standardized physician delivered phone surveys of patients who had axillary dissection for breast cancer (same oncologic surgeon cohort) prior to the implementation of ILR at the same institution. The study and control groups were matched based on history of adjuvant radiation and body mass index.

Results A cohort of patients between 2016 and 2019 with 2 years of follow-up after undergoing ILR (77 patients) were matched with those who did not undergo lymphatic reconstruction (94 patients). The incidence of lymphedema in the study group undergoing ILR was 10% (N = 8). In comparison, the incidence in the cohort who did not undergo lymphatic reconstruction was 38% (N = 36; p < 0.01). Patients with ILR had 92% lower odds of developing lymphedema (p < 0.01).

Conclusion ILR can significantly reduce the risk of developing BRCL in high-risk patients at 2 years of follow-up. Patients receiving adjuvant radiation therapy are more likely to develop BCRL after ILR compared with those who do not. Ongoing studies include investigation aimed at identifying patients most at risk for the development of BRCL to help target intervention as well as elucidate factors that contribute to the success of ILR.

Keywords

immediate lymphatic reconstruction - breast cancer-related lymphedema - axillary lymph node dissection - breast cancer

Note

This study was presented at the American Society for Reconstructive Microsurgery, Carlsbad, CA 2022.




Publication History

Received: 12 May 2023

Accepted: 31 July 2023

Accepted Manuscript online:
14 August 2023

Article published online:
22 September 2023

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