Immediate Implant Reconstruction Is Associated With a Reduced Risk of Lymphedema Compared to Mastectomy Alone: A Prospective Cohort Study. Issue 2 (February 2016)

• Record Type: Journal Article
• Authors: Miller, Cynthia L.; Colwell, Amy S.; Horick, Nora; Skolny, Melissa N.; Jammallo, Lauren S.; O'Toole, Jean A.; Shenouda, Mina N.; Sadek, Betro T.; Swaroop, Meyha N.; Ferguson, Chantal M.; Smith, Barbara L.; Specht, Michelle C.; Taghian, Alphonse G.
• Is Part Of: Annals of surgery. Volume 263:Issue 2(2016:Feb.)
• Page Start: 399
• Page End: 405
• Publication Date: 2016-02
• Subjects: autologous -- breast reconstruction -- immediate reconstruction -- implant -- lymphedema -- mastectomy; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000001128
• Languages: English
• ISSNs: 0003-4932

Abstract

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: A total of 616 patients with breast cancer who underwent 891 mastectomies between 2005 and 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 preoperatively and during postoperative follow-up using a Perometer. Lymphedema was defined as 10% or more arm volume increase compared to preoperative. 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 as follows: 4.08% [95% confidence interval (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 [hazards ratio (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. Conclusions: 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.