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American Association of Plastic Surgeons

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Comparative Analysis Of Two Year Lymphedema Rates After Axillary Lymphadenectomy With And Without Immediate Lymphatic Reconstruction
Cagri Cakmakoglu, M.D1, Hirsh Shah, B.S2, Stephanie Valente, M.D1, Risal Djohan, M.D1, Stephen Grobmyer, M.D1, Steven Bernard, M.D1, Diane Radford, M.D1, Zahraa AlHilli, M.D1, Raffi Gurunluoglu, M.D, PhD1, Andrea Moreira, M.D1, Graham Schwarz, M.D1.
1Cleveland Clinic Foundation, Cleveland, OH, USA, 2University of Toledo College of Medicine, Toledo, OH, USA.

Background:
Surgical treatment in breast cancer includes the current standard of axillary lymph node dissection (ALND). Lymphedema rates after these procedures range from 11-30%. We hypothesize that our innovative lymphedema prevention surgical (LPS) paradigm, ALND with axillary reverse mapping (ARM) and lymphatico-venous bypass (LVB), lowers the risk of lymphedema. Here, we present findings from a case control study from patients undergoing this procedure.
Methods:
LPS was performed in 91 consecutive patients with complete ALND at our institution from 9/2016-9/2019. Concurrently, 92 patients who underwent ALND without LPS from 9/2016-11/2017 were selected as a control group to prevent surgical technique/ learning curve bias. The outcomes of patients in both groups were analyzed via chart review.
Results:
The mean follow-up time for the non-LPS and LPS patients were 29.1 and 16.5 months, respectively Average non-LPS and LPS ages and BMI’s were 53.8 years and 28 kg/m2 and 51.7 years and 27.5 kg/m2, respectively. Non-LPS patients had a lymphedema rate of 13% whereas LPS patients had a significantly lower rate at 5% per bioimpedance spectroscopy and arm circumference measurements. Rates of post mastectomy radiation therapy were similar (77% to 89%, respectively), but significantly lower for neoadjuvant chemotherapy (43% vs 74%). The mean number of lymph nodes removed and with metastases were 11.2 vs 14 and 2.8 vs 2.6, respectively.
Conclusion:
Optimizing lymphatic preservation and restoring antegrade lymphatic flow with LPS, significantly decreases short term lymphedema rates in patients undergoing axillary lymphadenectomy for breast cancer. 


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