Positive impact of delayed breast reconstruction on breast-cancer treatment-related arm lymphoedema.

Abstract

The study aims to determine the impact of delayed breast reconstruction on women with breast-cancer treatment-related lymphoedema after mastectomy. Twenty women with breast-cancer treatment-related arm lymphoedema prospectively requesting breast reconstruction were included between January 2002 and June 2009. Lymphoedema volume was calculated for each 5-cm segment using the formula for a truncated cone. Three patients underwent transverse rectus abdominis myocutaneous flap reconstruction, five received pedicled latissimus dorsi myocutaneous flaps associated with a breast implant and 12 a breast implant (silicone) alone. Median lymphoedema duration at the time of breast reconstruction was 21 (interquartile range (IQR): 17-34) months. Breast reconstruction was done a median of 30 (IQR: 23-56) months after mastectomy. The median lymphoedema volume at medians of 5 (244 ml, IQR: 159-435) and 22 months (235 ml, IQR: 146-361) of follow-up after reconstruction compared to that measured 6 months before breast reconstruction of 378 ml (IQR: 261-459) were significantly lower (p<0.02 for both). Specific lymphoedema treatment, unchanged during the study, included manual lymph drainage for all women, elastic sleeves for 19 and low-stretch bandages for 14. Delayed breast reconstruction is feasible for women who have developed lymphoedema after mastectomy for breast cancer. Further studies are needed to compare the different breast-reconstruction techniques and to determine their ideal timing (immediate or delayed).