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Purpose: The early detection and current treatment of breast cancer is decreasing the mortality associated with a disease that affects one in eight American women. As breast cancer survivorship increases, the associated morbidities that impact daily life are gaining awareness. Lymphedema incidence is reported in 8-25% of all breast cancer survivors and the causative factors of lymphedema are still not fully understood. Every year more women are choosing to undergo reconstructive breast procedures, and it is not known if breast cancer reconstruction has any impact on the incidence of lymphedema.
Methods: All patients undergoing mastectomy with and without immediate breast reconstruction between 2001 and 2006 were identified in two independent and prospective databases. These databases were cross-referenced to remove any duplication of individuals. To reduce variation of known predictive factors the individuals were cross-matched for age, axillary intervention, and postoperative axillary radiation. Lymphedema incidence was based on presence of unilateral arm edema that lasted greater than six months and was documented on clinical exam.
Means and standard deviations were used to summarize continuous variable. Frequencies and proportions were used to present the categorical clinical characteristics. Univariate and multivariate regression modeling was used to assess the effect of predictive factors on the incidence of lymphedema and time to development of lymphedema. All tests were two-sided and a p value of <0.05 was considered significant.
Results: Of the 574 cross-matched patients included in the study, 78 breasts (6.8%) developed lymphedema, 21 in reconstructed breasts and 57 in unreconstructed breasts. The two groups varied slightly in BMI, race, and comorbidities such as diabetes, hypertension, and smoking. Patients without breast reconstruction were significantly more likely to develop lymphedema (9.9% vs 3.7%, p<0.001). Patients receiving postoperative axillary radiation (OR:4.74, 95% CI=2.70-8.31, p<0.001) , having 1 or more positive lymph nodes (OR:1.97, 95% CI=1.17-3.31, p=0.010), and BMI greater than 25 (OR:1.95, 95% CI=1.11-3.44, p=0.021) were associated with an increased incidence of lymphedema. Breast reconstructive patients developed lymphedema significantly slower compared to non-reconstructed patients (HR=0.42, 95%CI=0.26-0.87, p<0.001) The mean lymphedema-free time was 87.5±1.0 months for non-reconstructive patients and 100.3±0.7 months for breast reconstructive patients. The lympedema rates for non-reconstructive vs. reconstructive patients, were 4.4% vs. 1.0% at 12 months, 7.9% vs. 2.3% at 36 months and 9.9% vs. 3.7% at 60 months.
Conclusions: Patients undergoing breast reconstruction have a lower incidence and delay in onset of breast cancer related lymphedema compared to patients undergoing mastectomy alone when cross -matched for age, axillary intervention and postoperative axillary radiation.