Relationship of Immediate Breast Reconstruction and the Development of Lymphedema in Breast Cancer Patients With Radiation Therapy.

Abstract

Breast cancer-related lymphedema (BCRL) is often challenging to manage, and knowledge of how to prevent it is limited. There are several well-known risk factors, but recent studies have also suggested the potential association of immediate breast reconstruction with lower incidence, albeit with inconclusive results. Thus, we explored the impact of immediate breast reconstruction on lymphedema incidence in patients with breast cancer who underwent a mastectomy and adjuvant radiation therapy (RT). We retrospectively reviewed 440 patients with breast cancer who underwent a mastectomy with adjuvant RT from 2012 to 2020. Of these, 229 underwent immediate breast reconstruction (IR) group, and 211 underwent no reconstruction (NR) group. BCRL events were defined and graded on a scale of 0-3 following the International Society of Lymphology staging system. After excluding patients who experienced BCRL before RT (n = 30), with propensity score-matching, we used log-rank analysis and multivariate Cox regression models to identify associated factors. Then, the clinical course of BCRL was explored with flow diagrams. After a median follow-up period of 35 months, 116 patients (26%) developed BCRL, with 74% classified as International Society of Lymphology stage 2-3. Two-year actuarial rate of BCRL was 16.3% for the IR group, and 28.9% for the NR group (P = .020). In a multivariate Cox regression of propensity score-matched cohort (n = 180), patients were more likely to develop stage ≥2 BCRL if ≥15 axillary lymph nodes were resected (P = .035), or intensity modulated RT was given (P = .004). However, IR was associated with a lower incidence of BCRL (P = .022). Regarding patients with initial stage 0 or 1 BCRL, the IR group showed a lower rate of progression during follow-up compared with the NR group (33% vs 60%). In postmastectomy patients with breast cancer, resection of ≥15 axillary lymph nodes, as well as intensity modulated RT, were found to be significantly associated with lymphedema occurrence. Notably, IR may be associated with a lower incidence of lymphedema.