Risk Factors Associated with Breast Lymphedema

Abstract

Introduction The development of breast lymphedema (BLE) following breast/axillary surgery is poorly characterized. We prospectively evaluated clinical and surgical factors associated with development of BLE. Methods Patients undergoing unilateral breast-conserving surgery were prospectively enrolled preoperatively and followed for development of BLE. To augment the number of patients with BLE for evaluation of risk factors, postoperative patients identified in the clinic with signs and symptoms of BLE were also enrolled. Logistic regression with Firth’s penalized likelihood bias-reduction method was used for univariate and multivariate analysis. Results Of 144 women, 124 of them were enrolled preoperatively (38 of whom developed BLE) and 20 women with BLE were enrolled postoperatively. Any type of axillary surgery was the strongest factor associated with BLE (odds ratio 134, 95% CI: 18 to >1000). All 58 BLE events occurred in women with axillary surgery as compared to none of the 46 patients without axillary surgery (p<0.0001). Among 98 women who underwent axillary surgery, BLE did not occur more often after ALND versus SLN biopsy (p=0.38) and was not associated with total number of nodes removed (p=0.52). In multivariate analysis, factors associated with the development of BLE in the axillary surgery subgroup included baseline BMI (p=0.004), incision location (p=0.009), and prior surgical biopsy (p=0.01). Conclusions Risk of BLE is primarily related to performance of any axillary surgery but not extent of axillary surgery or number of lymph nodes removed. Other factors associated with BLE were increased BMI, incision location, and prior surgical excisional biopsy.

The Impact of Radiation Therapy, Lymph Node Dissection, and Hormonal Therapy on Outcomes of Tissue Expander–Implant Exchange in Prosthetic Breast Reconstruction

“…Risk factors include removal of more than five axillary lymph nodes, obesity, and axillary radiation therapy. [39][40][41][42] Although traditional clinical guidelines for patients at risk of developing breast cancer-related lymphedema included postoperative restrictions on upper body activity, recent studies have demonstrated that upper body strength training is not only safe but appears to reduce the risk of postoperative breast cancer-related lymphedema. 43 Thus, the inclusion of a graduated weight-training program after the initial mastectomy and reconstruction is a crucial part of the postoperative regimen for patients undergoing axillary lymph node dissection to optimize lymphatic drainage.…”

Comments on “supermicrosurgical lymphaticovenous anastomosis for a patient with breast lymphedema secondary to breast cancer treatment”

“…We would like to congratulate Dr. Giacalone, Dr. Yamamoto and colleagues on a very well written and interesting article (Giacalone & Yamamoto, 2017) that brings into attention one surprisingly neglected aspect of the secondary breast lymphedema in cancer therapy. As stated from our colleagues, breast lymphedema is a not seldom occurrence after breast conserving therapy and axillary lymphnode dissection (Boughey et al, 2014;Degnim et al, 2012). In the case of extremity lymphedema, conservative treatment represents the first line of therapy.…”

Update on Post-mastectomy Lymphedema Management

“…In the USA and other parts of the developed world, malignancy and its treatment, including surgery and radiation, are the most common secondary causes of lymphedema . Additionally, elements, such as obesity, extent of axillary surgery, radiotherapy, infection, and trauma, have been identified as factors predisposing to lymphedema .…”