60. TRUNK LYMPHEDEMA FOLLOWING BREAST CANCER SURGERY: AN ANATOMIC AND FUNCTIONAL STUDY

Abstract

PURPOSE: In the upper and lower extremities, ICG-lymphangiography has proven valuable in characterizing the lymph channel dysfunction (anatomic) and dermal backflow (functional) changes seen in early and late-stage lymphedema. We propose to use ICG-lymphangiography to evaluate if trunk and breast lymphedema occur following breast cancer surgery. METHODS: All patients undergoing second stage or revision surgery following breast reconstruction were offered ICG-based lymphangiography screening of upper extremities, chest, or breast. Twenty-nine patients selected chest and breast lymphangiography. 25 mg of indocyanine green (Akorn, Inc., Illinois) diluted in 10cc of sterile water was injected intradermally (0.1 cc) at the distal-most extent of the axillary drainage territory of each hemi-trunk. 60 minutes following injection, the breast and trunk were visualized with the PDE Neo II (Hamamatsu, Japan) using the fluorescence mode and evaluated using Koshima patterns of dermal backflow. RESULTS: 52 sides (29 patients) were included in the study. 8 sides underwent neither surgery nor radiation and were considered controls. No lymphedema was identified within the control cohort. Of the 42 non-control/functional transit sides, 35 sides (76%) had some form of dermal backflow abnormality. Severe dermal backflow (diffuse pattern) was seen most commonly in the anterior trunk (37%), lateral trunk (24%), and inferior breast (22%). CONCLUSION: We report clear evidence that following breast cancer surgery, lymphedema occurs throughout the trunk and breast. Severe dysfunction appears to be located around the inferior-lateral aspect of the breast and chest wall. This may explain post-mastectomy breast/chest wall heaviness and dysesthesia.