Impact of Obesity on Surgical and Patient-Reported Outcomes Following Immediate Lymphatic Reconstruction

While obesity is a known risk factor for developing breast cancer-related lymphedema (BCRL) after axillary lymph node dissection (ALND), its impact on outcomes of immediate lymphatic reconstruction (ILR) is yet to be elucidated. The purpose of this study is to assess the influence of obesity on BCRL incidence and patient-reported outcomes following ILR.We retrospectively studied consecutive patients who underwent ILR following ALND between 2017 and 2024 across a university hospital system. BCRL prevalence and condition-specific (LYMPH-Q) quality-of-life performance were compared and correlated via multivariable regression.We identified 172 patients (mean body mass index [BMI]: 29.5 ± 6.9 kg/m²) with 72 patients (41.9%) categorized as obese (BMI ≥ 30). BCRL incidence was 7.0% with no significant difference between groups (obese, 8.3% vs. nonobese, 6.0%; <i>p</i> = 0.553). In adjusted models, obesity was not associated with higher risk of BCRL (OR, 0.90; 95% CI, 0.23-3.47; <i>p</i> = 0.875), surgical complications (OR, 1.18; 95% CI, 0.50-2.74, <i>p</i> = 0.708) or unplanned reoperation (OR, 0.72; 95% CI, 0.29-1.80, <i>p</i> = 0.479). However, obese patients showed significantly lower mean scores in the LYMPH-Q symptom scale (66.7 ± 27.7 vs. 84.7 ± 16.8, <i>p</i> = 0.004) when compared with nonobese patients. In adjusted models, obesity was associated with independently lower LYMPH-Q symptom scores (-13.8; 95% CI, -26.7 to -0.81; <i>p</i> = 0.038).ILR mitigated the risk of BCRL associated with obesity following ALND. However, obesity remained associated with significantly worse patient-reported lymphedema symptom burden following ILR. These findings highlight a dissociation between objective risk reduction and subjective symptom burden, underscoring the need for integrated assessment and targeted symptom management protocols.