title: Immediate Implant Reconstruction Is Associated With a Reduced Risk of Lymphedema Compared to Mastectomy Alone: A Prospective Cohort Study.
abstract: OBJECTIVE
  We sought to determine the risk of lymphedema associated with immediate breast reconstruction compared to mastectomy alone.
  
  
  BACKGROUND
  Immediate breast reconstruction is increasingly performed at the time of mastectomy. Few studies have examined whether breast reconstruction impacts development of lymphedema.
  
  
  METHODS
  A total of 616 patients with breast cancer who underwent 891 mastectomies between 2005 and 2013 were prospectively screened for lymphedema at our institution, with 22.2 months' median follow-up. Mastectomies were categorized as immediate implant, immediate autologous, or no reconstruction. 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. Kaplan-Meier and Cox regression analyses were performed to determine lymphedema rates and risk factors.
  
  
  RESULTS
  Of 891 mastectomies, 65% (580/891) had immediate implant, 11% (101/891) immediate autologous, and 24% (210/891) no reconstruction. The two-year cumulative incidence of lymphedema was as follows: 4.08% [95% confidence interval (CI): 2.59-6.41%] implant, 9.89% (95% CI: 4.98-19.1%) autologous, and 26.7% (95% CI: 20.4-34.4%) no reconstruction. By multivariate analysis, immediate implant [hazards ratio (HR): 0.352, P < 0.0001] but not autologous (HR: 0.706, P = 0.2151) reconstruction was associated with a significantly reduced risk of lymphedema compared to no reconstruction. Axillary lymph node dissection (P < 0.0001), higher body mass index (P < 0.0001), and greater number of nodes dissected (P = 0.0324) were associated with increased lymphedema risk.
  
  
  CONCLUSIONS
  This prospective study suggests that in patients for whom implant-based reconstruction is available, immediate implant reconstruction does not increase the risk of lymphedema compared to mastectomy alone.
authors.affiliation: *Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA †Department of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA ‡Department of Biostatistics, Massachusetts General Hospital, Boston, MA §Department of Physical and Occupational Therapy, Massachusetts General Hospital, Boston, MA ¶Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Miller
authors.forename: Amy S
authors.initials: AS
authors.lastname: Colwell
authors.forename: Nora
authors.initials: N
authors.lastname: Horick
authors.forename: Melissa N
authors.initials: MN
authors.lastname: Skolny
authors.forename: Lauren S
authors.initials: LS
authors.lastname: Jammallo
authors.forename: Jean A
authors.initials: JA
authors.lastname: O'Toole
authors.forename: Mina N
authors.initials: MN
authors.lastname: Shenouda
authors.forename: Betro T
authors.initials: BT
authors.lastname: Sadek
authors.forename: Meyha N
authors.initials: MN
authors.lastname: Swaroop
authors.forename: Chantal M
authors.initials: CM
authors.lastname: Ferguson
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Smith
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Specht
authors.forename: Alphonse G
authors.initials: AG
authors.lastname: Taghian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019928:Breast Implantation; D001943:Breast Neoplasms / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008209:Lymphedema / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D008408:Mastectomy; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome