Incidence Of Breast Cancer Related Lymphedema In Patients With Anatomy Not Amenable To Immediate Lymphatic Reconstruction
Nicole K. Le, MD1, Robert M. Rotatori, MD1, D'Arcy J. Wainwright, MD1, Brielle Weinstein, MD1, Tina Tavares, RN2, Nicholas J. Panetta, MD1.
1University of South Florida Department of Plastic Surgery, Tampa, FL, USA, 2Department of Women's Oncology, Breast Program, Moffitt Cancer Center, Tampa, FL, USA.
PURPOSE: Immediate lymphatic reconstruction (ILR) at the time of axillary lymph node dissection (ALND) is emerging as the standard of care to decrease breast cancer related lymphedema (BCRL). In a subset of patients undergoing ALND, anatomic disparities intraoperatively prevent ILR from occurring. The aim was to determine the incidence of lymphedema in this population.
METHODS: Patients referred to a Multidisciplinary Lymphedema clinic for ILR at the time of ALND from 2016 through 2021 were retrospectively identified through a prospectively maintained database. Absence/development of BCRL was ascertained through analysis of patient reported symptoms, circumferential limb measurements, and bioimpedance spectroscopy. Patient characteristics, perioperative factors, and oncologic treatment history were reviewed.
RESULTS: 28 patients met inclusion. Mean age 55 years and BMI 29 kg/m2. Mean follow up 553 days. 28% of patients had previous oncologic breast and axillary surgery prior to ALND. Therapeutic adjuncts included adjuvant radiation (82%), neoadjuvant chemotherapy (82%), adjuvant chemotherapy (32%). ILR was not performed due to lymphatics not visualized (43%) and anatomic disparities between identified lymphatics and preserved venules (57%). Thirteen patients (46%) had intact lymphatic channels visualized coursing outside the field of nodal extirpation. Eight patients (29%) developed BCRL during follow up. None of the studied characteristics/factors were statistically significant for development of BCRL.
CONCLUSION: Data presented demonstrates 29% incidence of BCRL. This represents a decrease in BCRL compared to historical ALND cohorts, but an increase compared to those receiving ILR. Continued close post-operative monitoring is recommended until further studies can risk stratify this cohort of patients.
Back to 2022 Posters