title: Tissue expander breast reconstruction is not associated with an increased risk of lymphedema.
abstract: BACKGROUND
  Recent reports have demonstrated that lymphedema can occur after even minor pertubation of the axillary region such as sentinel lymph node biopsy (SLNB). The impact of breast reconstruction on the development of lymphedema, however, remains unknown. Therefore, the purpose of this study was to determine the impact of immediate tissue expander breast reconstruction on the risk of developing lymphedema.
  
  
  METHODS
  We identified patients who had undergone mastectomy with SLNB or SLNB and axillary lymph node dissection (ALND) with or without breast reconstruction using our prospectively maintained lymphedema and breast reconstruction databases. The development of lymphedema was evaluated prospectively using arm measurements and a validated questionnaire. Associations between variables were examined. Logistic regression was used to examine the association of reconstruction on prevalence of lymphedema while adjusting individually for BMI, age, and weight gain after surgery.
  
  
  RESULTS
  Characteristics of patients with or without reconstruction were similar except for age, BMI, and weight gain since surgery. Median follow-up was 5 years. Among patients treated with mastectomy with SLNB or SLNB/ALND, those undergoing reconstruction had a lower rate of measured lymphedema than those who did not (5% vs. 18%, P < .0004). The reconstructed group also had fewer patients with both measured and self-reported lymphedema (3% vs. 12%, P < .002). Differences in the rates of measured lymphedema between groups persisted following univariate logistical regression for differences in age, BMI, and weight gain.
  
  
  CONCLUSIONS
  Tissue expander breast reconstruction in patients undergoing SLNB or SLNB/ALND does not increase the risk of developing measured or perceived lymphedema.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Tomer
authors.initials: T
authors.lastname: Avraham
authors.forename: Sanjay V
authors.initials: SV
authors.lastname: Daluvoy
authors.forename: Elyn R
authors.initials: ER
authors.lastname: Riedel
authors.forename: Peter G
authors.initials: PG
authors.lastname: Cordeiro
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Van Zee
authors.forename: Babak J
authors.initials: BJ
authors.lastname: Mehrara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision; D008209:Lymphedema / Q000209:etiology*; D016462:Mammaplasty / Q000009:adverse effects*; D008408:Mastectomy; D012307:Risk Factors; D015625:Tissue Expansion Devices / Q000009:adverse effects*