• Annals of surgery · Feb 2016

    Comparative Study Clinical Trial

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

    • Cynthia L Miller, Amy S Colwell, Nora Horick, Melissa N Skolny, Lauren S Jammallo, Jean A O'Toole, Mina N Shenouda, Betro T Sadek, Meyha N Swaroop, Chantal M Ferguson, Barbara L Smith, Michelle C Specht, and Alphonse G Taghian.
    • *Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA †Department of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA ‡Department of Biostatistics, Massachusetts General Hospital, Boston, MA §Department of Physical and Occupational Therapy, Massachusetts General Hospital, Boston, MA ¶Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA.
    • Ann. Surg. 2016 Feb 1; 263 (2): 399-405.

    ObjectiveWe sought to determine the risk of lymphedema associated with immediate breast reconstruction compared to mastectomy alone.BackgroundImmediate breast reconstruction is increasingly performed at the time of mastectomy. Few studies have examined whether breast reconstruction impacts development of lymphedema.MethodsA 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.ResultsOf 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.ConclusionsThis 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.

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