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J Reconstr Microsurg
DOI: 10.1055/a-2717-5063
Original Article

Impact of Obesity on Surgical and Patient-reported Outcomes Following Immediate Lymphatic Reconstruction

Authors

  • Abbas M Hassan

    1   Plastic Surgery, Indiana University School of Medicine, Indianapolis, United States (Ringgold ID: RIN12250)

  • John P Hajj

    1   Plastic Surgery, Indiana University School of Medicine, Indianapolis, United States (Ringgold ID: RIN12250)

  • John P Lewis

    1   Plastic Surgery, Indiana University School of Medicine, Indianapolis, United States (Ringgold ID: RIN12250)

  • Carla Suzanne Fisher

    2   Surgery, Indiana University School of Medicine, Indianapolis, United States (Ringgold ID: RIN12250)

  • Folasade O Imeokparia

    1   Plastic Surgery, Indiana University School of Medicine, Indianapolis, United States (Ringgold ID: RIN12250)

  • Kandice K. Ludwig

    3   Division of Breast Surgery, Indiana University School of Medicine, Indianapolis, United States (Ringgold ID: RIN12250)

  • Rachel M. Danforth

    4   Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, United States (Ringgold ID: RIN12250)

  • R Jason VonDerHaar

    1   Plastic Surgery, Indiana University School of Medicine, Indianapolis, United States (Ringgold ID: RIN12250)

  • Ravinder Bamba

    5   Plastic Surgery, Indiana University, Indianapolis, United States

  • Mary E. Lester

    4   Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, United States (Ringgold ID: RIN12250)

  • Aladdin Hassanein

    1   Plastic Surgery, Indiana University School of Medicine, Indianapolis, United States (Ringgold ID: RIN12250)

Gefördert durch: IUSM Inclusive Excellence Resident Scholar Program
Gefördert durch: National Institute of Health Sciences K08HL167164
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Background: While obesity is a known risk-factor for developing breast cancer–related lymphedema (BCRL) after axillary lymph node dissection (ALND), its impact on outcomes of immediate lymphatic reconstruction (ILR) is yet to be elucidated. The purpose of this study is to assess the influence of obesity on BCRL incidence and patient-reported outcomes (PROs) following ILR. Methods: We retrospectively studied consecutive patients who underwent ILR following ALND between 2017 and 2024 across a university hospital system. BCRL prevalence and condition-specific (LYMPH-Q) quality-of-life performance was compared and correlated via multivariable regression. Results: We identified 172 patients (mean BMI 29.5±6.9 kg/m²) with 72 patients (41.9%) categorized as obese (BMI≥30). BCRL incidence was 7.0% with no significant difference between groups (obese, 8.3% vs. non-obese, 6.0%; p=0.553). In adjusted models, obesity was not associated with higher risk of BCRL (OR, 0.90; 95%CI, 0.23–3.47; p=0.875), surgical complications (OR, 1.18; 95%CI, 0.50-2.74, p= 0.708) or unplanned reoperation (OR, 0.72; 95%CI, 0.29-1.80, p=0.479). However, obese patients showed significantly lower mean scores in the LYMPH-Q symptom scale (66.7 ± 27.7 vs. 84.7 ± 16.8, p=0.004) when compared with non-obese patients. In adjusted models, obesity was associated with independently lower LYMPH-Q symptom scores (, -13.8; 95%CI, -26.7 to -0.81; p=0.038). Conclusions: ILR mitigated the risk of BCRL associated with obesity following ALND. However, obesity remained associated with significantly worse patient-reported lymphedema symptom burden following ILR. These findings highlight a dissociation between objective risk reduction and subjective symptom burden, underscoring the need for integrated assessment and targeted symptom management protocols.



Publikationsverlauf

Eingereicht: 27. Juni 2025

Angenommen nach Revision: 21. September 2025

Accepted Manuscript online:
09. Oktober 2025

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