Reply: reduced incidence of breast cancer-related lymphedema following mastectomy and breast reconstruction versus mastectomy alone.

BACKGROUND As breast cancer survivorship has increased, so has an awareness of the morbidities associated with its treatment. The incidence of breast cancer-related lymphedema has been reported to be 8 to 30 percent in all breast cancer survivors. To determine whether breast cancer reconstruction has an impact on the incidence of breast cancer-related lymphedema, the authors compared its incidence in patients who underwent mastectomy with reconstruction versus mastectomy alone. METHODS All patients who underwent mastectomy, with or without immediate breast reconstruction, between 2001 and 2006, were identified through a search of prospective institutional databases. To reduce variation caused by known predictive factors, the individuals were cross-matched for age, axillary intervention, and postoperative axillary irradiation. The incidence of lymphedema was based on the presence of arm edema that lasted more than 6 months and was documented clinically. RESULTS Of the 574 cross-matched patients included in the study, 78 (6.8 percent) developed lymphedema (21 with reconstructed breasts and 57 with unreconstructed breasts). Patients who did not undergo reconstruction were significantly more likely to develop breast cancer-related lymphedema (9.9 percent versus 3.7 percent; p < 0.001). Postoperative axillary radiation therapy (p < 0.001), one or more positive lymph nodes (p = 0.010), and body mass index of 25 or greater (p = 0.021) were also associated with an increased incidence of lymphedema. Reconstruction patients developed lymphedema significantly later than nonreconstruction patients (p < 0.001). CONCLUSION Patients who undergo breast reconstruction have a lower incidence and a delay in onset of breast cancer-related lymphedema compared with patients who undergo mastectomy alone. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.