Tissue Expander Breast Reconstruction is Not Associated with an Increased Risk of Lymphedema
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
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.
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.
Tissue expander breast reconstruction in patients undergoing SLNB or SLNB/ALND does not increase the risk of developing measured or perceived lymphedema.
- Petrek JA, Senie RT, Peters M, Rosen PP. Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis. Cancer. 2001;92:1368–77. CrossRef
- Armer JM, Stewart BR. A comparison of four diagnostic criteria for lymphedema in a post-breast cancer population. Lymphat Res Biol. 2005;3:208–17. CrossRef
- McLaughlin SA, Wright MJ, Morris KT, Sampson MR, Brockway JP, Hurley KE, et al. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: patient perceptions and precautionary behaviors. J Clin Oncol. 2008;26:5220–6. CrossRef
- McLaughlin SA, Wright MJ, Morris KT, Giron GL, Sampson MR, Brockway JP, et al. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol. 2008;26:5213–9. CrossRef
- Elder EE, Brandberg Y, Björklund T, Rylander R, Lagergren J, Jurell G, et al. Quality of life and patient satisfaction in breast cancer patients after immediate breast reconstruction: a prospective study. Breast. 2005;14:201–8. CrossRef
- Preminger BA, Pusic AL, McCarthy CM, Verma N, Worku A, Cordeiro PG. How should quality-of-life data be incorporated into a cost analysis of breast reconstruction? A consideration of implant versus free TRAM flap procedures. Plast Reconstr Surg. 2008;121:1075–82. CrossRef
- Rowland JH, Desmond KA, Meyerowitz BE, Belin TR, Wyatt GE, Ganz PA. Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst. 2000;92:1422–9. CrossRef
- Vandeweyer E, Hertens D, Nogaret JM, Deraemaecker R. Immediate breast reconstruction with saline-filled implants: no interference with the oncologic outcome? Plast Reconstr Surg. 2001;107:1409–12. CrossRef
- McCarthy CM, Pusic AL, Sclafani L, Buchanan C, Fey JV, Disa JJ, et al. Breast cancer recurrence following prosthetic, postmastectomy reconstruction: incidence, detection, and treatment. Plast Reconstr Surg. 2008;121:381–8. CrossRef
- Langstein HN, Cheng MH, Singletary SE, Robb GL, Hoy E, Smith TL, et al. Breast cancer recurrence after immediate reconstruction: patterns and significance. Plast Reconstr Surg. 2003;111:712–20 (discussion 721–2). CrossRef
- Huang CJ, Hou MF, Lin SD, Chuang HY, Huang MY, Fu OY, et al. Comparison of local recurrence and distant metastases between breast cancer patients after postmastectomy radiotherapy with and without immediate TRAM flap reconstruction. Plast Reconstr Surg. 2006;118:1079–86 (discussion 1087–8). CrossRef
- Vandeweyer E, Deraemaecker R, Nogaret JM, Hertens D. Immediate breast reconstruction with implants and adjuvant chemotherapy: a good option? Acta Chir Belg. 2003;103:98–101.
- Howard MA, Polo K, Pusic AL, Cordeiro PG, Hidalgo DA, Mehrara B, et al. Breast cancer local recurrence after mastectomy and TRAM flap reconstruction: incidence and treatment options. Plast Reconstr Surg. 2006;117:1381–6. CrossRef
- Armer JM, Radina ME, Porock D, Culbertson SD. Predicting breast cancer-related lymphedema using self-reported symptoms. Nurs Res. 2003;52:370–9. CrossRef
- Cody HS III. The learning curve for sentinel lymph node biopsy in breast cancer. Arch Surg. 2000;135:605–6. CrossRef
- Avraham T, Clavin N, Mehrara BJ. Microsurgical breast reconstruction. Cancer J. 2008;14:241–7. CrossRef
- Mak SS, Yeo W, Lee YM, Mo KF, Tse KY, Tse SM, et al., Predictors of lymphedema in patients with breast cancer undergoing axillary lymph node dissection in Hong Kong. Nurs Res. 2008;57:416–25. CrossRef
- Goffman TE, Laronga C, Wilson L, Elkins D. Lymphedema of the arm and breast in irradiated breast cancer patients: risks in an era of dramatically changing axillary surgery. Breast J. 2004;10:405–11. CrossRef
- Armer J, Fu MR, Wainstock JM, Zagar E, Jacobs LK. Lymphedema following breast cancer treatment, including sentinel lymph node biopsy. Lymphology. 2004;37:73–91.
- Sakorafas GH, Peros G, Cataliotti L, Vlastos G. Lymphedema following axillary lymph node dissection for breast cancer. Surg Oncol. 2006;15:153–65. CrossRef
- Soran A, D’Angelo G, Begovic M, Ardic F, Harlak A, Samuel Wieand H, et al. Breast cancer-related lymphedema—what are the significant predictors and how they affect the severity of lymphedema? Breast J. 2006;12:536–43. CrossRef
- Beesley V, Janda M, Eakin E, Obermair A, Battistutta D. Lymphedema after gynecological cancer treatment : prevalence, correlates, and supportive care needs. Cancer. 2007;109:2607–14. CrossRef
- Sener SF, Winchester DJ, Martz CH, Feldman JL, Cavanaugh JA, Winchester DP, et al. Lymphedema after sentinel lymphadenectomy for breast carcinoma. Cancer. 2001;92:748–52. CrossRef
- Hinrichs CS, Watroba NL, Rezaishiraz H, Giese W, Hurd T, Fassl KA, et al. Lymphedema secondary to postmastectomy radiation: incidence and risk factors. Ann Surg Oncol. 2004;11:573–80. CrossRef
- Tissue Expander Breast Reconstruction is Not Associated with an Increased Risk of Lymphedema
Annals of Surgical Oncology
Volume 17, Issue 11 , pp 2926-2932
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors