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

Abbas M. Hassan; John P. Hajj; John P. Lewis; Carla S. Fisher; Folasade O. Imeokparia; Kandice K. Ludwig; Rachel M. Danforth; R. Jason VonDerHaar; Ravinder Bamba; Mary E. Lester; Aladdin H. Hassanein

doi:10.1055/a-2717-5063

Journal of Reconstructive Microsurgery, Inhaltsverzeichnis

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

¹Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States
John P. Hajj

¹Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States
John P. Lewis

¹Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States
Carla S. Fisher

²Division of Breast Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States
Folasade O. Imeokparia

²Division of Breast Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States
Kandice K. Ludwig

²Division of Breast Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States
Rachel M. Danforth

¹Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States
R. Jason VonDerHaar

¹Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States
Ravinder Bamba

¹Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States
Mary E. Lester

¹Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States
Aladdin H. Hassanein

¹Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States

Abstract

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 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 were compared and correlated via multivariable regression.

Results

We identified 172 patients (mean body mass index [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. nonobese, 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 nonobese 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).

Conclusion

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.

Keywords

ILR - lympha - lymphedema - breast cancer - obesity

Volltext

Referenzen

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