title: Reduced incidence of breast cancer-related lymphedema following mastectomy and breast reconstruction versus mastectomy alone.
abstract: 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).
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Houston, Texas From the Department of Plastic Surgery and the Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center.
authors.forename: Annika
authors.initials: A
authors.lastname: Card
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Crosby
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.forename: Wayne A
authors.initials: WA
authors.lastname: Lindstrom
authors.forename: Anthony
authors.initials: A
authors.lastname: Lucci
authors.forename: David W
authors.initials: DW
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008209:Lymphedema / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome