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. 2023 Nov 1;152(5):773e-778e.
doi: 10.1097/PRS.0000000000010381. Epub 2023 Mar 8.

A 4-Year Institutional Experience of Immediate Lymphatic Reconstruction

Melisa D Granoff  1 , Aaron Fleishman  2 , Kathy Shillue  3 , Anna Rose Johnson  4 , JoEllen Ross  2 , Bernard T Lee  1 , Paige Teller  5 , Ted A James  2 , Dhruv Singhal  1
Affiliations

A 4-Year Institutional Experience of Immediate Lymphatic Reconstruction

Melisa D Granoff et al. Plast Reconstr Surg. .

Abstract

Background: Up to one in three patients may go on to develop breast cancer-related lymphedema (BCRL) after treatment. Immediate lymphatic reconstruction (ILR) has been shown in early studies to reduce the risk of BCRL, but long-term outcomes are limited because of its recent introduction and institutions' differing eligibility requirements. This study evaluated the incidence of BCRL in a cohort that underwent ILR over the long term.

Methods: A retrospective review of all patients referred for ILR at the authors' institution from September of 2016 through September of 2020 was performed. Patients with preoperative measurements, a minimum of 6 months of follow-up data, and at least one completed lymphovenous bypass were identified. Medical records were reviewed for demographics, cancer treatment data, intraoperative management, and lymphedema incidence.

Results: A total of 186 patients with unilateral node-positive breast cancer underwent axillary nodal surgery and an attempt at ILR over the study period. Ninety patients underwent successful ILR and met all eligibility criteria, with a mean patient age of 54 ± 12.1 years and median body mass index of 26.6 kg/m 2 [interquartile range (IQR), 24.0 to 30.7 kg/m 2 ]. The median number of lymph nodes removed was 14 (IQR, eight to 19). Median follow-up was 17 months (range, 6 to 49 months). Eighty-seven percent of patients underwent adjuvant radiotherapy, and among them, 97% received regional lymph node irradiation. The overall rate of lymphedema was 9% at the end of the study period.

Conclusions: With the use of strict follow-up guidelines over the long term, the authors' findings support that ILR at the time of axillary lymph node dissection is an effective procedure that reduces the risk of BCRL in a high-risk patient population.

Clinical question/level of evidence: Therapeutic, IV.

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