Abstract
Background
Whether the breast reconstruction modality could influence the long-term development
of post-mastectomy lymphedema has been little investigated. The present study aimed
to evaluate the potential association of the breast reconstruction method with the
incidence of lymphedema over an extended follow-up period.
Methods
Patients with breast cancer who underwent immediate reconstruction from 2008 to 2014
were reviewed. They were categorized into three groups according to the reconstruction
method: tissue expander/implant, abdominal flaps, and latissimus dorsi (LD) muscle
flaps. Differences in the cumulative incidence of lymphedema by the reconstruction
method were analyzed, as well as their independent influence on the outcome. Further
analyses were conducted with propensity-score matching for baseline characteristics.
Results
In total, 664 cases were analyzed with a median follow-up of 83 months (402 prostheses,
180 abdominal flaps, and 82 LD flaps). The rate of axillary lymph node dissection
was significantly higher in the LD flap group than in the other two groups. The 5-year
cumulative incidences of lymphedema in the LD flap, abdominal flap, and prosthesis
groups were 3.7%, 10.6%, and 10.9%, respectively. In multivariable analyses, compared
to the use of the LD flap, that of tissue expander/implant and that of abdominal flaps
were associated with increased risks of lymphedema. A similar association was observed
in the propensity-score matching analysis. The use of abdominal flaps or prostheses
was not associated with the outcomes.
Conclusions
Our results suggest that the method of immediate breast reconstruction might be associated
with the development of postmastectomy lymphedema.
Keywords
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Article info
Publication history
Published online: January 31, 2023
Accepted:
January 24,
2023
Received in revised form:
January 6,
2023
Received:
July 12,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
