Miller, C.L., Colwell, A.S., Horick, N., Skolny, M.N., Jammallo, L.S., O'Toole, J.A., . . . Taghian, A.G. (2016). Immediate implant reconstruction is associated with a reduced risk of lymphedema compared to mastectomy alone: A prospective cohort study. Annals of Surgery, 263, 399–405.
To determine the risk of lymphedema associated with immediate breast reconstruction compared to mastectomy alone
Patients were screened for lymphedema prospectively, and lymphedema rates were compared between those who had immediate breast implantation, immediate autologous reconstruction, and those who had mastectomy alone. Each breast was considered individually in analysis. Follow-up was a median of 22.2 months.
PHASE OF CARE: Late effects and survivorship
Prospective cohort study
Arm measurements were performed preoperatively and during postoperative follow-up using a perometer. Lymphedema was defined as 10% or more arm volume increase compared to preoperative. Measurement was adjusted for body weight.
Overall incidence of lymphedema was 10.58%. Among those who had immediate breast reconstruction, the incidence of lymphedema was 5.13% compared to 26.66% among those with no immediate reconstruction. Both immediate implantation (HR = 0.172, p < 0.0001) and autologous (HR = 0.467, p = 0.0077) were associated with reduced risk of lymphedema compared to no reconstruction. Factors associated with increased risk of lymphedema were a body mass index greater than or equal to 30, axillary lymph node dissection (ALND), and number of lymph nodes dissected.
Immediate implantation reconstruction does not appear to increase the risk of lymphedema compared to mastectomy alone; however, the findings are limited by significant differences in cohort characteristics shown to be associated with lymphedema incidence.
Nurses should be advised that although immediate reconstruction may not increase the risk of lymphedema, risk reduction for this population should continue.