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The Impact of Lymphedema on Patient-Reported Outcomes After Breast Reconstruction: A Preliminary Propensity Score-Matched Analysis

  • Reconstructive Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Studies on the impact of secondary lymphedema on patient-reported satisfaction and quality of life following postmastectomy breast reconstruction are limited by their heterogeneity. We aimed to reduce heterogeneity in study sample populations and compare BREAST-Q Reconstruction Module scores of patients with lymphedema matched to patients without lymphedema.

Methods

We identified patients who underwent postmastectomy breast reconstruction from 2009 to 2017 and performed a propensity score-matched analysis to compare patient-reported outcomes of patients who developed lymphedema with those who did not. Matched covariates included age, body mass index, race/ethnicity, smoking history, radiation or chemotherapy exposure, postoperative infection, and reconstruction modality and laterality. Outcomes of interest were pre- and postoperative BREAST-Q scores for Satisfaction with Breasts, Physical Well-being of the Chest, Sexual Well-Being, and Psychosocial Well-Being; the minimal clinically important difference (MCID) was four points.

Results

Matched cohorts included 322 patients per group. Preoperative BREAST-Q scores did not differ between lymphedema and non-lymphedema matched cohorts. Postoperative BREAST-Q scores were significantly lower in lymphedema patients: Physical Well-Being of the Chest (all time points), Satisfaction with Breast (at 1 and 2 years), Sexual Well-Being (at 2 years), and Psychosocial Well-Being (at 2 and 3 years). All significant differences in average scores were greater than the MCID.

Conclusions

Patients with breast cancer-related lymphedema reported significantly lower Physical Well-Being of the Chest, Satisfaction with Breasts, Sexual Well-Being, and Psychosocial Well-Being at various time points. Our findings may prove useful for patient counseling and justify the need for further research on the prevention and treatment of this devastating disease.

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Acknowledgment

The authors would like to acknowledge Dagmar Schnau for her contributions towards editing and preparing this manuscript.

Funding

This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748, which supports Memorial Sloan Kettering Cancer Center’s research infrastructure.

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Author notes

  1. Michelle Coriddi and Leslie N. Kim contributed equally to this work and are credited as co-first authors.

Authors and Affiliations

  1. Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 321 East 61st St, 6th Floor, New York, NY, USA

    Michelle Coriddi MD, Leslie N. Kim MD, Kathryn Haglich MS, Leslie McGrath NP, Jasmine J. L. Monge BS, Meghana G. Shamsunder MS, Babak J. Mehrara MD, Joseph H. Dayan MD & Jonas A. Nelson MD, MPH

Authors
  1. Michelle Coriddi MD
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  2. Leslie N. Kim MD
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Contributions

MC contributed substantially to this study, including study conception and design; data analysis and interpretation; manuscript drafting and revisions; and approval of the final version. LNK contributed to data collection, analysis, and interpretation; manuscript drafting and revisions; and approval of final version. KH contributed to data analysis and interpretation; manuscript drafting and revisions; and approval of final version. LM contributed to data collection and analysis and approval of final version. MGS contributed to data analysis and interpretation, and approval of final version. BJM contributed to study conception and design; data analysis and interpretation; manuscript drafting and revisions; and approval of the final version. JHD contributed to study design and conception; manuscript drafting and revisions; and approval of final version. JAN contributed to study conception and design; data analysis and interpretation; manuscript drafting and revisions; and approval of the final version.

Corresponding authors

Correspondence to Michelle Coriddi MD or Jonas A. Nelson MD, MPH.

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Disclosures

Joseph H. Dayan is a paid consultant for Stryker Corporation and the director of Welwaze Corporation. Babak Mehrara is a consultant for PureTech Corporation and receives research funding from Regeneron. Michelle Coriddi, Leslie N. Kim, Kathryn Haglich, Leslie McGrath, Jasmine J.L. Monge, Meghana G. Shamsunder and Jonas A. Nelson have no disclosures to declare, financial or otherwise.

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Coriddi, M., Kim, L.N., Haglich, K. et al. The Impact of Lymphedema on Patient-Reported Outcomes After Breast Reconstruction: A Preliminary Propensity Score-Matched Analysis. Ann Surg Oncol 30, 3061–3071 (2023). https://doi.org/10.1245/s10434-022-12994-z

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