Abstract
PURPOSE: Following mastectomy, over 20% of women experience lymphedema. Previous studies suggest a possible protective effect of breast reconstruction against lymphedema development. This study analyzes risk of developing post-mastectomy lymphedema following autologous reconstruction by flap-type and temporality using a real-time, federated electronic medical record network (TriNetX Inc, Cambridge, MA). METHODS: 85,776,922 de-identified patient records were retrospectively screened from 2006-2021. 60,157 post-mastectomy patients aged 18-99 met criteria and were allocated into paired cohorts using common procedural terminology codes. Cohorts were then compared to assess lymphedema outcomes relative to timing (immediate vs. delayed) and flap-type (DIEP/TRAM/latissimus). Paired cohorts were compared and stratified by timing of reconstruction. Outcomes were assessed following stringent balancing for age, race, radiation, chemotherapy, hormone therapy, smoking, diabetes, obesity, and axillary lymph node dissection. Post-operative lymphedema rates within 2, 5, and 10-years of mastectomy were analyzed. RESULTS: DIEP and latissimus patients demonstrated significantly decreased risk of lymphedema compared to mastectomy without reconstruction across all time points; DIEP (Risk Ratio (RR): 0.487-0.546, 95% Confidence Interval (95%CI): 0.411-0.651,p<0.001), latissimus (RR:0.567-0.638,95%CI:0.423-0.828],p<0.001). Delayed DIEP was associated with significantly reduced post-mastectomy lymphedema risk versus immediate DIEP reconstruction within 10 years (0.639-0.652[0.459-0.889], p<0.01). CONCLUSION: Our analysis examines the potential protective effect against lymphedema of various approaches to autologous breast reconstruction. Limitations include this study’s retrospective nature and reliance on medical coding. Future prospective studies are warranted to confirm whether autologous breast reconstruction, and specifically delayed DIEPs, may be protective against post-mastectomy lymphedema.
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