Delayed Breast Reconstruction on Patients With Upper Extremity Lymphedema

Abstract

Background Breast cancer–related lymphedema (BCRL) is a debilitating condition with morbidity, hindered quality of life, and increased health-related costs. Experimental studies support the use of musculocutaneous flaps for managing animal models with lymphedema. Although vascularized lymph node transfer (VLNT) and lymphovenous anastomosis are used to surgically treat patients with lymphedema, it is not known whether musculocutaneous or adipocutaneous flaps (eg, delayed autologous breast reconstruction) are effective for treating refractory upper extremity BCRL. We conducted a systematic review and pooled analysis to assess the impact of delayed breast reconstruction on developed BCRL. Methods Following PRISMA guidelines, we systematically searched PubMed, Scopus, EMBASE, and Google Scholar databases for relevant studies published through November 11, 2016. We screened 934 unique articles. Of these, we conducted full-text and reference screening on 37 articles. We then performed a pooled and sensitivity analysis using random effects. Results Eight studies met our inclusion criteria. One study was a case report; 7 studies were case series with sample sizes ranging from 3 to 38 patients. According to our pooled analysis 58% of patients reported improvement after breast reconstruction with or without VLNT. Sensitivity analysis revealed that 84% (95% confidence interval, 0.74–0.95) of patients who underwent breast reconstruction and VLNT reported improvement, whereas only 22% (95% confidence interval, 0.12–0.32) of those who had breast reconstruction alone reported improvement. Conclusions Our review summarizes the current evidence regarding the effect of delayed breast reconstruction on established lymphedema. The VLNT component of the autologous breast reconstruction procedures may be the largest contributing factor leading to lymphedema improvement.

Integrated Treatment of Breast Cancer-related Lymphedema: A Descriptive Review of the State of the Art

“…Nonetheless, it has been demonstrated that a flap introduced into a LYE affected area serves as a trigger to the formation of new lymphatic vessels (68), because providing roots for lymph outflow. Finally, all the studies reviewed by Sotos agree that delayed breast reconstruction does not have a role in worsening BCRL (69).…”

Lymph node transfer combined with deep inferior epigastric perforators and transverse rectus abdominis myocutaneous procedures: a systematic review

“…According to Siotos et al, patients affected with breast-cancer related lymphedema were more likely to experience improvement after autologous breast reconstruction, regardless of whether VLNT was performed simultaneously. That being said, if VLNT was included in the procedure, it was noted a 4-fold increase in the chance of patients reporting a positive outcome (14).…”

Study protocol for a 10-year prospective observational study, examining lymphoedema and patient-reported outcome after breast reconstruction

“…Surgery in lymphoedema treatment has shown promising results using different approaches such as lymphaticovenular bypass, inguinal lymph node transfer, autologous lymph vessel transplantation, lymphatic venous anastomosis and suction-assisted lipectomy, 84–90 and delayed autologous breast reconstruction was found to improve lymphoedema symptoms in a study by Siotos et al . 91 Treatment of subclinical lymphoedema with compression garments has shown to be effective but requires early diagnosis. 92 Further studies are needed to set a new gold standard and personalise lymphoedema treatment, and we expect our study to supply data for this, as treatment of lymphoedema also will be recorded.…”