Reconstruction and Lymphedema

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Reconstruction and Lymphedema

Posted 6/26/2010

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I do know this is an arcane topic that will be of interest to only a select few. I also know that, for those select few, it may be of extreme interest. When a woman is considering reconstruction after mastectomy, she may or may not consider the possibility of increasing her risk of lymphedema. This is a fairly uncommon syndrome, but one that causes a lot of discomfort and unhappiness to those who do experience it. This summary from Annals of Surgical Oncology of a study by Avraham and colleagues at Memorial Sloan Kettering found that at least one kind of reconstruction, tissue expander, did not increase the risk of lymphedema. Here is the summary and a reminder to talk with your doctor if this is part of your experience.

Tissue Expander Breast Reconstruction is Not Associated with an Increased Risk of Lymphedema

Journal Annals of Surgical Oncology

SpringerLink Date Tuesday, May 25, 2010

Tomer Avraham1, Sanjay V. Daluvoy1, Elyn R. Riedel1, Peter G. Cordeiro1,

Kimberly J. Van Zee1 and Babak J. Mehrara1

(1) Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, 10

Abstract

Background

Recent reports have demonstrated that lymphedema can occur after even minor pertubation of the axillary region such as sentinel lymph node biopsy (SLNB). The impact of breast reconstruction on the development of lymphedema, however, remains unknown. Therefore, the purpose of this study was to determine the impact of immediate tissue expander breast reconstruction on the risk of

developing lymphedema.

Materials and Methods

We identified patients who had undergone mastectomy with SLNB or SLNB and axillary lymph node dissection (ALND) with or without breast reconstruction using our prospectively maintained lymphedema and breast reconstruction databases. The development of lymphedema was

evaluated prospectively using arm measurements and a validated questionnaire. Associations between variables were examined. Logistic regression was used to examine the association of reconstruction on prevalence of lymphedema while adjusting individually for BMI, age, and weight gain after surgery.

Results

Characteristics of patients with or without reconstruction were similar except for age, BMI, and weight gain since surgery. Median follow-up was 5 years. Among patients treated with mastectomy with SLNB or SLNB/ALND, those undergoing reconstruction had a lower rate of

measured lymphedema than those who did not (5% vs. 18%, P < .0004). The reconstructed group also had fewer patients with both measured and self-reported lymphedema (3% vs. 12%, P < .002). Differences in the rates of measured lymphedema between groups persisted following

univariate logistical regression for differences in age, BMI, and weight gain.

Conclusions

Tissue expander breast reconstruction in patients undergoing SLNB or SLNB/ALND does not increase the risk of developing measured or perceived lymphedema.