Immediate Implant Reconstruction Is Associated With a Reduced Risk of Lymphedema Compared to Mastectomy Alone

Abstract

STRUCTURED ABSTRACT Objective We sought to determine the risk of lymphedema associated with immediate breast reconstruction compared to mastectomy alone. Background Immediate breast reconstruction is increasingly performed at the time of mastectomy. Few studies have examined whether breast reconstruction impacts development of lymphedema. Methods 616 breast cancer patients who underwent 891 mastectomies between 2005–2013 were prospectively screened for lymphedema at our institution, with 22.2 months median follow-up. Mastectomies were categorized as immediate implant, immediate autologous, or no reconstruction. Arm measurements were performed pre-operatively and during post-operative follow-up using a Perometer. Lymphedema was defined as ≥10% arm volume increase compared to pre-operative. Kaplan-Meier and Cox regression analyses were performed to determine lymphedema rates and risk factors. Results Of 891 mastectomies, 65% (580/891) had immediate implant, 11% (101/891) immediate autologous, and 24% (210/891) no reconstruction. The two-year cumulative incidence of lymphedema was: 4.08% (95% CI: 2.59–6.41%) implant, 9.89% (95% CI: 4.98–19.1%) autologous, and 26.7% (95% CI: 20.4–34.4%) no reconstruction. By multivariate analysis, immediate implant (HR: 0.352, p<0.0001) but not autologous (HR: 0.706, p=0.2151) reconstruction was associated with a significantly reduced risk of lymphedema compared to no reconstruction. Axillary lymph node dissection (p<0.0001), higher Body Mass Index (p<0.0001), and greater number of nodes dissected (p=0.0324) were associated with increased lymphedema risk. Conclusion This prospective study suggests that in patients for whom implant-based reconstruction is available, immediate implant reconstruction does not increase the risk of lymphedema compared to mastectomy alone.

Method of breast reconstruction and the development of lymphoedema

“…According to a recent systematic review based on 72 studies of lymphoedema following breast cancer treatment, the overall estimated incidence of lymphoedema was 16·6 (range 13·6–20·2) per cent. Compared with those results, the incidence of lymphoedema in the present study was lower, suggesting that immediate breast reconstruction may reduce the risk of lymphoedema, and supporting the results of previous studies.…”

“…The benefits of immediate prosthetic or autologous breast reconstruction in reducing the risk of lymphoedema have been suggested by several studies. In the present study, conducted with patients undergoing immediate breast reconstruction, the 2‐year cumulative incidence of lymphoedema was 6·8 per cent.…”

“…These studies found a protective effect on lymphoedema in women who underwent either autologous or prosthetic breast reconstruction. Autologous reconstruction using well vascularized tissue and prosthetic reconstruction using an implant can create different environments in the chest wall, which may influence the development of lymphoedema.…”

“…Recently, the potential impact of breast reconstruction on lymphoedema has drawn attention, with the suggestion that delayed autologous breast reconstruction may not be associated with an increased risk of lymphoedema and may even reduce the severity of existing lymphoedema. In addition, several studies have demonstrated that women undergoing immediate breast reconstruction following mastectomy have a significantly lower incidence of lymphoedema compared with those having mastectomy alone, suggesting that immediate reconstruction might reduce the risk of subsequent development of lymphoedema.…”

Diagnostic Methods, Risk Factors, Prevention, and Management of Breast Cancer-Related Lymphedema: Past, Present, and Future Directions

“…The cohort consisted of 616 individual patients with 891 total mastectomies. After 2 years, 26.7% of patients without an implant developed BCRL, 9.9% of patients opting for the immediate autologous developed BCRL, and only 4% of patients who opted for the immediate implant developed BCRL [62]. These results demonstrate that reconstruction, specifically immediate reconstruction, can result in a lower BCRL risk when compared to no breast reconstruction following a mastectomy.…”