title: Risk factors associated with breast lymphedema.
abstract: BACKGROUND
  The development of breast lymphedema (BLE) after breast/axillary surgery is poorly characterized. We prospectively evaluated clinical and surgical factors associated with development of BLE.
  
  
  METHODS
  Patients undergoing unilateral breast-conserving surgery were prospectively enrolled preoperatively and followed for development of BLE. To augment the number of patients with BLE for evaluation of risk factors, postoperative patients identified in the clinic with signs and symptoms of BLE were also enrolled. Logistic regression with Firth's penalized likelihood bias-reduction method was used for univariate and multivariate analysis.
  
  
  RESULTS
  Of 144 women, 124 were enrolled preoperatively (38 of whom developed BLE), and 20 women with BLE were enrolled postoperatively. Any type of axillary surgery was the strongest factor associated with BLE (odds ratio, 134; 95 % confidence interval, 18 to >1,000). All 58 BLE events occurred in women with axillary surgery as compared with no events in the 46 patients without axillary surgery (p < 0.0001). Among 98 women who underwent axillary surgery, BLE did not occur more often after axillary lymph node dissection versus sentinel lymph node biopsy (p = 0.38) and was not associated with total number of nodes removed (p = 0.52). In multivariate analysis, factors associated with the development of BLE in the axillary surgery subgroup included baseline BMI (p = 0.004), incision location (p = 0.009), and prior surgical biopsy (p = 0.01).
  
  
  CONCLUSIONS
  Risk of BLE is primarily related to performance of any axillary surgery but not the extent of axillary surgery or number of lymph nodes removed. Other factors associated with BLE were increased body mass index, incision location, and prior surgical excisional biopsy.
authors: Department of Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Judy C
authors: JC
authors: Boughey
authors: Tanya L
authors: TL
authors: Hoskin
authors: Andrea L
authors: AL
authors: Cheville
authors: Joyce
authors: J
authors: Miller
authors: Margie D
authors: MD
authors: Loprinzi
authors: Kristine M
authors: KM
authors: Thomsen
authors: Shaun
authors: S
authors: Maloney
authors: Larry M
authors: LM
authors: Baddour
authors: Amy C
authors: AC
authors: Degnim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008209:Lymphedema / Q000209:etiology*; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects*