Immediate Implant Reconstruction Is Associated With a Reduced Risk of Lymphedema Compared to Mastectomy Alone: A Prospective Cohort Study

• Published in: Annals of surgery Vol. 263; no. 2; pp. 399 - 405
• Main 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
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-02-2016
• Subjects: Adult; Aged; Aged, 80 and over; Breast Implantation; Breast Neoplasms - surgery; Carcinoma, Ductal, Breast - surgery; Carcinoma, Intraductal, Noninfiltrating - surgery; Female; Follow-Up Studies; Humans; Incidence; Kaplan-Meier Estimate; Lymphedema - epidemiology; Lymphedema - etiology; Lymphedema - prevention & control; Mastectomy; Middle Aged; Multivariate Analysis; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Proportional Hazards Models; Prospective Studies; Risk Factors; Treatment Outcome
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/SLA.0000000000001128

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 follows4.08% [95% confidence interval (CI)2.59–6.41%] implant, 9.89% (95% CI4.98–19.1%) autologous, and 26.7% (95% CI20.4–34.4%) no reconstruction. By multivariate analysis, immediate implant [hazards ratio (HR)0.352, P < 0.0001] but not autologous (HR0.706, 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.