D34. Oncoplastic Reduction Mammoplasty: A Means to Decrease the Incidence of Breast Lymphedema

PURPOSE: Large-breasted women may face increased asymmetry and morbidity after breast conservation therapy (BCT). Recent data demonstrates a higher risk of breast lymphedema (BL) associated with macromastia. We aim to understand if performing immediate oncoplastic reduction mammaplasty (ORM) at the time of lumpectomy improves the rate of BL. METHODS: Retrospective chart review was performed on women who underwent BCT alone vs BCT with ORM followed by radiation from 2014-2023. BL was defined as swelling that persisted beyond one year after radiation. Demographics, treatment, and post-operative complications were compared. Descriptive statistics were used to analyze differences in outcomes between breast volumes. Regression analysis was used to evaluate factors associated with BL and the efficacy of ORM in decreasing BL. RESULTS: The overall rate of BL was 9.1%. 1,079 patients underwent BCT. 70 underwent ORM (6.5%) and 1009 (93.5%) underwent BCT alone. Black race, increased BMI, preoperative breast volume >1500 grams, presence of axillary lymph node dissection, chemotherapy, radiation dose, and incidence of cellulitis, seroma, and arm lymphedema all increased the risk of BL. Women who underwent ORM did demonstrate a trend (p=.0587) toward a decreased rate of BL when stratifying by preoperative breast volume: >1500 (10.5%) vs <1500 (0%). Regression analysis demonstrated that women with >1500-gram breasts who did not undergo ORM were 3.7 times more likely to develop BL than ORM (p=0.024). CONCLUSION: It is important to consider the increased incidence of BL in macromastia. Our study demonstrates ORM’s potential protection against BL for breast volume greater than 1500 grams.