Patients often ask us if breast reconstruction after mastectomy increases their risk of lymphedema. Several studies in the past suggest that breast reconstruction does not increase lymphedema risk. In a recent study published in October, researchers compared the number of patients who developed lymphedema in three surgical groups: mastectomy alone, immediate expander or implant and immediate reconstruction with autologous tissue (patients’ own tissue, such as TRAM flap). Immediate reconstruction refers to reconstruction performed at the time of the mastectomy.
In this study, 616 patients with breast cancer who had a total of 891 mastectomies were prospectively screened for lymphedema and followed for an average of 22 months. Arm measurements were performed preoperatively and during postoperative follow-up using a Perometer like the one used at TurningPoint. For the purpose of this study, lymphedema was defined as 10% or more arm volume increase* compared to preoperative.
Researchers controlled for variables that are known to increase lymphedema risk, such as the number of nodes removed, BMI and radiation so that they could compare the groups on the basis of reconstruction procedure alone. The study found reduced lymphedema risk in patients with immediate expander/implant reconstruction compared to mastectomy alone and autologous reconstruction.
The mechanism by which immediate expander/implant reconstruction appears to reduce lymphedema risk is not known, and further research is needed. However, based on this study and others, it is safe to conclude that immediate reconstruction does not appear to increase lymphedema risk and, in the case of expanders/implants, may actually decrease lymphedema risk.
Miller CL et al. Immediate Implant Reconstruction Is Associated With a Reduced Risk of Lymphedema Compared to Mastectomy Alone: A Prospective Cohort Study. Ann Surg. Oct 10, 2015 [Epub ahead of print]
*(Note to TurningPoint patients: In TurningPoint’s model of lymphedema surveillance and management, 10% lymphedema is considered to be moderate lymphedema. When we are measuring you in the clinic, we define lymphedema as an increase of more than 3-5% above your baseline measures and we take into consideration visible swelling and symptoms of lymphedema such as heaviness sensation of the arm).