67. Breast Reconstruction Timing and Method Do Not Affect Lymphedema Development in a Study of Post-mastectomy Patients

PURPOSE: Breast-cancer related lymphedema (BCRL) is a high-morbidity complication that is commonly seen in around 1 in 5 women seeking breast reconstruction. Risk factors including lymphatic surgery, radiation, and body mass index (BMI) are well-known. There is limited data examining reconstruction method and lymphedema risk. We seek the relationship between the timing and method of breast reconstruction and the risk of lymphedema. METHODS: Patients who received consultation regarding breast reconstruction at a single academic institution 2019 through 2023 were retrospectively reviewed. Demographics, oncological, reconstructive, and lymphedema disease characteristics were collected. Patients receiving multiple reconstructions, autologous and implant reconstruction in a single breast, and less than one year of post-reconstruction follow-up were excluded. Lymphedema diagnoses were determined if the patient attended lymphedema therapy or was diagnosed by a physician. The characteristics of lymphedema and non-lymphedema cohorts were compared using an independent t-test and chi-squared test of independence. Multivariate logistic regressions were performed. RESULTS: 761 patients met inclusion criteria, 213 (28.0%) of whom were diagnosed with upper extremity lymphedema at any time after mastectomy. Compared to patients without lymphedema, patients with a lymphedema diagnosis were more likely to have higher BMI (median 29.0 kg/m2 versus 28.3 kg/m2, p=0.039) and receive radiation treatment (68.1% versus 43.1%, p<0.001). There were no significant differences in reconstruction method or timing. When controlling for age, BMI, lymphatic surgery, radiation, and receiving breast reconstruction, only radiation predicted developing lymphedema in all patients (p<0.001). In those patients who decided to undergo breast reconstruction, radiation remained the only predictor of developing lymphedema at any time point (p<0.001) when controlling for autologous versus implant reconstruction, delayed versus immediate reconstruction, lymphatic surgery, radiation and BMI. Additionally, radiation remained the only significant predictor of developing lymphedema after reconstruction when controlling for the same variables (p=0.011). CONCLUSION: Within our patient cohort, reconstruction type and timing does not significantly impact lymphedema incidence. These results may inform patient-physician decision making when consulting for reconstruction. Future studies should focus on utilizing quantitative lymphedema data, including lymphedema staging, to better define lymphedema severity in this population.