Journal time.
The May 2012 issue of Plastic cand Reconstructive Surgery Journal had an article out of Houston, Texas looking at lymphedema following immediate breast cancer reconstruction.
What is lymphedema? Lymphedema is swelling caused by issues with your lymphatic drainage. Your arm has two things which bring blood and other things back into your body’s circulation: veins and lymphatics. Your lymphatics run along your inner arm, through your armpit (where it goes through the nodes), and then dumps the lymphatic fluid into your venous system.
If the lymphatic system doesn’t function or is blocked, then imagine instead of two major highways running up the arm, you only have one. You would have swelling of your arm and hand. In Bay Area kind of terms, imagine instead of 280 and 101 on the Peninsula to go to San Francisco, you only have one major highway. Ack. Can you imagine the traffic and back up on that one highway? Traffic would block up the city streets. Nothing would move.
That is what lymphedema is like.
Rates of lymphedema have decreased over time, as we switched to a modified radical mastectomy from a full mastectomy, and sentinel node biopsies instead of removing lots of lymph nodes. Radiation increases the risk. As does your lymph node status.
They still estimate 20% of breast cancer survivors have lymphedema.
So does immediate reconstruction affect this? Does the type of reconstruction affect lymphedema?
Study:
- Single institution between 2001 and 2006
- Comparison of patients and reconstruction type: implant expander reconstruction, latissimus and implant reconstruction, or autologous flap alone
- 1117 patients were studied
- Mean follow up 56 months
Findings?
- Lymphedema was in 4%
- Reconstruction type had no significant effect on incidence or ttime to lymphedema
- Lymphedema was higher in those with high BMI, axillary surgeries, and high numbers of positive lymph nodes