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J Reconstr Microsurg 2024; 40(04): 262-267
DOI: 10.1055/a-2153-2203
Original Article

Immediate Lymphatic Reconstruction in 77 Consecutive Breast Cancer Patients: 2-year Follow-up

Nicole K. Le 
1   Department of Plastic Surgery, University of South Florida, Tampa, Florida
,
Brielle Weinstein
1   Department of Plastic Surgery, University of South Florida, Tampa, Florida
,
Jeegan Parikh
2   Global Communicable Diseases, College of Public Health, University of South Florida, Tampa, Florida
,
Lokesh A. Coomar
3   Department of Surgery, Center for Anatomical Science and Education, Saint Louis University School of Medicine, St. Louis, Missouri
,
D'Arcy Wainwright
1   Department of Plastic Surgery, University of South Florida, Tampa, Florida
,
Langfeier Liu
1   Department of Plastic Surgery, University of South Florida, Tampa, Florida
,
Jamila Mammadova 
1   Department of Plastic Surgery, University of South Florida, Tampa, Florida
,
Tina Tavares
4   Department of Women's Oncology, Breast Program, Moffitt Cancer Center, Tampa, Florida
,
Nicholas J. Panetta
1   Department of Plastic Surgery, University of South Florida, Tampa, Florida
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Abstract

Background Breast cancer-related lymphedema (BCRL) is a cyclical, progressive disease that begins at the time of axillary dissection and worsens in the setting of adjuvant oncologic therapies. The paradigm of lymphedema management in these patients is shifting from therapeutic surgeries and decongestive therapy to preventative surgery with immediate lymphatic reconstruction (ILR).

Methods After institutional review board approval, a prospective database was maintained of all patients undergoing ILR. Patients were excluded if they had preoperative lymphedema or expired during the study period. All ILR were performed by the senior author. A control group was established with standardized physician delivered phone surveys of patients who had axillary dissection for breast cancer (same oncologic surgeon cohort) prior to the implementation of ILR at the same institution. The study and control groups were matched based on history of adjuvant radiation and body mass index.

Results A cohort of patients between 2016 and 2019 with 2 years of follow-up after undergoing ILR (77 patients) were matched with those who did not undergo lymphatic reconstruction (94 patients). The incidence of lymphedema in the study group undergoing ILR was 10% (N = 8). In comparison, the incidence in the cohort who did not undergo lymphatic reconstruction was 38% (N = 36; p < 0.01). Patients with ILR had 92% lower odds of developing lymphedema (p < 0.01).

Conclusion ILR can significantly reduce the risk of developing BRCL in high-risk patients at 2 years of follow-up. Patients receiving adjuvant radiation therapy are more likely to develop BCRL after ILR compared with those who do not. Ongoing studies include investigation aimed at identifying patients most at risk for the development of BRCL to help target intervention as well as elucidate factors that contribute to the success of ILR.

Keywords

immediate lymphatic reconstruction - breast cancer-related lymphedema - axillary lymph node dissection - breast cancer

Note

This study was presented at the American Society for Reconstructive Microsurgery, Carlsbad, CA 2022.




Publication History

Received: 12 May 2023

Accepted: 31 July 2023

Accepted Manuscript online:
14 August 2023

Article published online:
22 September 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol 2013; 14 (06) 500-515
    CrossrefPubMedGoogle Scholar
  • 2 Grabb WC, Smith JW. Plastic Surgery. 2nd ed.. Little; 1973: 717-721 :chap Lymphedema
    Google Scholar
  • 3 Coriddi M, Mehrara B, Skoracki R, Singhal D, Dayan JH. Immediate lymphatic reconstruction: technical points and literature review. Plast Reconstr Surg Glob Open 2021; 9 (02) e3431
    CrossrefPubMedGoogle Scholar
  • 4 Rodriguez JR, Fuse Y, Yamamoto T. Microsurgical strategies for prophylaxis of cancer-related extremity lymphedema: a comprehensive review of the literature. J Reconstr Microsurg 2020; 36 (07) 471-479
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Jeon HB, Jung JH, Im SH. et al. Association between immediate breast reconstruction and the development of breast cancer-related lymphedema. Plast Reconstr Surg 2023; 151 (02) 214e-222e
    CrossrefPubMedGoogle Scholar
  • 6 Johnson AR, Kimball S, Epstein S. et al. Lymphedema incidence after axillary lymph node dissection: quantifying the impact of radiation and the lymphatic microsurgical preventive healing approach. Ann Plast Surg 2019; 82 (4S, Suppl 3): S234-S241
    CrossrefPubMedGoogle Scholar
  • 7 Granoff MD, Fleishman A, Shillue K. et al. A four-year institutional experience of immediate lymphatic reconstruction. Plast Reconstr Surg 2023; 152 (05) 773e-778e
    CrossrefPubMedGoogle Scholar
  • 8 Weinstein B, Le NK, Robertson E. et al. Reverse lymphatic mapping and immediate microsurgical lymphatic reconstruction reduces early risk of breast cancer-related lymphedema. Plast Reconstr Surg 2022; 149 (05) 1061-1069
    CrossrefPubMedGoogle Scholar
  • 9 Johnson AR, Bravo MG, James TA, Suami H, Lee BT, Singhal D. The all but forgotten mascagni-sappey pathway: learning from immediate lymphatic reconstruction. J Reconstr Microsurg 2020; 36 (01) 28-31
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Granoff MD, Pardo J, Shillue K. et al. Variable anatomy of the lateral upper arm lymphatic channel: a potential anatomic risk factor for the development of breast cancer related lymphedema. Plast Reconstr Surg 2023; 152 (02) 422-429
    CrossrefPubMedGoogle Scholar
  • 11 Boccardo F, Casabona F, De Cian F. et al. Lymphatic microsurgical preventing healing approach (LYMPHA) for primary surgical prevention of breast cancer-related lymphedema: over 4 years follow-up. Microsurgery 2014; 34 (06) 421-424
    CrossrefPubMedGoogle Scholar
  • 12 Boccardo F, Casabona F, De Cian F. et al. Lymphedema microsurgical preventive healing approach: a new technique for primary prevention of arm lymphedema after mastectomy. Ann Surg Oncol 2009; 16 (03) 703-708
    CrossrefPubMedGoogle Scholar
  • 13 Chiang SN, Skolnick GB, Westman AM, Sacks JM, Christensen JM. National outcomes of prophylactic lymphovenous bypass during axillary lymph node dissection. J Reconstr Microsurg 2022; 38 (08) 613-620
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 McDuff SGR, Mina AI, Brunelle CL. et al. Timing of lymphedema after treatment for breast cancer: when are patients most at risk?. Int J Radiat Oncol Biol Phys 2019; 103 (01) 62-70
    CrossrefPubMedGoogle Scholar
  • 15 Hara Y, Otsubo R, Shinohara S. et al. Lymphedema after axillary lymph node dissection in breast cancer: prevalence and risk factors-a single-center retrospective study. Lymphat Res Biol 2022; 20 (06) 600-606
    CrossrefPubMedGoogle Scholar
  • 16 Le NK, Weinstein B, Serraneau K, Tavares T, Laronga C, Panetta N. The learning curve: trends in the first 100 immediate lymphatic reconstructions performed at a single institution. Ann Plast Surg 2021; 86 (6S, Suppl 5): S495-S497
    CrossrefPubMedGoogle Scholar
  • 17 Le NK, Liu L, Jesus Cruz R. et al. Efficacy of immediate lymphatic reconstruction in prevention of breast cancer-related lymphedema. Ann Plast Surg 2023; 90 (6S, Suppl 4): S363-S365
    CrossrefPubMedGoogle Scholar
  • 18 Tsai RJ, Dennis LK, Lynch CF, Snetselaar LG, Zamba GK, Scott-Conner C. The risk of developing arm lymphedema among breast cancer survivors: a meta-analysis of treatment factors. Ann Surg Oncol 2009; 16 (07) 1959-1972
    CrossrefPubMedGoogle Scholar
  • 19 Shaitelman SF, Chiang YJ, Griffin KD. et al. Radiation therapy targets and the risk of breast cancer-related lymphedema: a systematic review and network meta-analysis. Breast Cancer Res Treat 2017; 162 (02) 201-215
    CrossrefPubMedGoogle Scholar
  • 20 Warren LE, Miller CL, Horick N. et al. The impact of radiation therapy on the risk of lymphedema after treatment for breast cancer: a prospective cohort study. Int J Radiat Oncol Biol Phys 2014; 88 (03) 565-571
    CrossrefPubMedGoogle Scholar