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American Association of Plastic Surgeons

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A Four-year Institutional Experience Of Immediate Lymphatic Reconstruction
Anna Rose Johnson, MD, MPH1, Melisa Granoff, BA2, Aaron Fleishman, MPH2, Kathy Shillue, PT, DPT, OCS, CLT2, Bernard T. Lee, MD, MPH, MBA2, Paige Teller, MD3, Ted James, MD2, Dhruv Singhal, MD2.
1Washington University in St. Louis, St. Louis, MO, USA, 2Beth Israel Deaconess Medical Center, Boston, MA, USA, 3Maine Medical Center, Portland, ME, USA.

PURPOSE: Up to one in three breast cancer patients undergoing axillary lymph node dissection (ALND) and radiation develop breast cancer related lymphedema (BCRL). Immediate lymphatic reconstruction (ILR) is a surgical procedure that has been shown in early studies to reduce the risk of BCRL. However, longer-term outcomes are limited. This study evaluates the incidence of BCRL in a cohort that underwent ILR over the long-term.
METHODS: A retrospective review of patients brought to the OR for ILR at our institution from September 1st, 2016 until September 1st, 2020 was performed. Patients with preoperative measurements not consistent with lymphedema, at least one bypass performed, and minimum 6-months follow-up were identified. Records were reviewed for demographics, cancer treatment data, intra-operative management, and lymphedema incidence. Eligible patients were followed through February 2021.
RESULTS: A total of 186 women with unilateral node-positive breast cancer underwent ALND and attempted ILR. 90 patients underwent successful ILR and met inclusion/exclusion criteria. Mean age was 53.9 (SD 12.5) years and median BMI 26.6 (Q1-Q3 24.0-29.9) kg/m2. Median number of lymph nodes removed was 14 (8-19). 87% of patients underwent adjuvant radiotherapy of which 97% received regional lymph node radiation. Median follow-up was 17 months (range: 6-49). 15.5% had a minimum of 1 surveillance visit consistent with lymphedema. At the study conclusion, 6.7% had resolved. The final rate of BCRL was 8.8%.
CONCLUSION: Utilizing strict follow-up guidelines over the long-term, our findings support ILR at time of axillary surgery as a safe procedure that reduces the risk of BCRL.


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