title: Breast reconstruction and risk of lymphedema after mastectomy: A prospective cohort study with 10 years of follow-up.
abstract: OBJECTIVE
  The aim of this study is to assess the incidence and risk factors for lymphedema in women submitted to mastectomy, with or without breast reconstruction.
  
  
  METHODS
  A cohort study was performed on women submitted to mastectomy with axillary lymphadenectomy in a single center. The follow-up included clinical evaluation and arm column measurements before surgery, at 30 days, 6 months, 5 years, and 10 years after surgery. For women subjected to late reconstruction, the time of occurrence of lymphedema (before or after reconstruction) was observed.
  
  
  RESULTS
  We followed up on 622 patients submitted to mastectomy and axillary lymphadenectomy for an average period of 57 months after surgery. In total, 94 women were submitted to breast reconstruction, 47 (8%) of them immediate and 47 (8%) late reconstructions. Incidence of lymphedema in the whole group was 33% (n = 204). Among the patients submitted to reconstruction, 28% of them developed lymphedema, on average, 93 months (CI 95%, 88-98) after surgical treatment. In women not subjected to reconstruction, 179 (34%) developed lymphedema, on average, after 106 months (CI 95%, 96-116) (p = 0.03). Breast reconstruction reduced lymphedema risk in 36% (HR = 0.64, CI 96%, 0.42-0.98, p = 0.04). After adjustment for pathological staging and radiotherapy, this was not statistically significant (HR = 0.79, CI 95%, 0.52-1.21, p = 0.28).
  
  
  CONCLUSIONS
  Breast reconstruction does not increase the risk of lymphedema in long-term follow-up.
authors.affiliation: Centro Universitário Augusto Motta, Programa de Pós-Graduação em Ciências da Reabilitação, Rio de Janeiro, Brazil. Electronic address: moniquemaron@gmail.com.
authors.forename: Monique M
authors.initials: MM
authors.lastname: Menezes
authors.affiliation: Instituto Nacional de Câncer, Hospital do Câncer III, Rio de Janeiro, Brazil. Electronic address: mabello@inca.gov.br.
authors.forename: Marcelo A
authors.initials: MA
authors.lastname: Bello
authors.affiliation: Instituto Nacional de Câncer, Hospital do Câncer III, Rio de Janeiro, Brazil. Electronic address: eduardomillen@uol.com.br.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Millen
authors.affiliation: Instituto Nacional de Câncer, Hospital do Câncer III, Rio de Janeiro, Brazil. Electronic address: fredericolucas@uol.com.br.
authors.forename: Frederico A S
authors.initials: FA
authors.lastname: Lucas
authors.affiliation: Instituto Nacional de Câncer, Hospital do Câncer III, Rio de Janeiro, Brazil. Electronic address: fcarvalho@inca.gov.br.
authors.forename: Flávia N
authors.initials: FN
authors.lastname: Carvalho
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Laboratório de Anatomia Médico Cirúrgica, São Paulo, Brazil. Electronic address: mauroand@uol.com.br.
authors.forename: Mauro F C
authors.initials: MF
authors.lastname: Andrade
authors.affiliation: Escola Nacional de Saúde Publica Sergio Arouca, Programa de Pós-Graduação em Saúde Pública e Meio Ambiente, Rio de Janeiro, Brazil. Electronic address: carol_padula@hotmail.com.
authors.forename: Ana Carolina P R
authors.initials: AC
authors.lastname: Pereira
authors.affiliation: Escola Nacional de Saúde Publica Sergio Arouca, Programa de Pós-Graduação em Saúde Pública e Meio Ambiente, Rio de Janeiro, Brazil. Electronic address: rosalina.koifman@hotmail.com.
authors.forename: Rosalina J
authors.initials: RJ
authors.lastname: Koifman
authors.affiliation: Instituto Nacional de Câncer, Programa de Carcinogese Molecular, Rio de Janeiro, Brazil. Electronic address: abergmann@inca.gov.br.
authors.forename: Anke
authors.initials: A
authors.lastname: Bergmann
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008209:Lymphedema / Q000209:etiology / Q000601:surgery*; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012307:Risk Factors
keywords: Breast neoplasia; Incidence; Lymphedema; Reconstruction; Risk factors