Inflammatory Breast Cancer-Related Lymphedema

Background: Breast cancer-related lymphedema (BCRL) is a potentially debilitating outcome following breast cancer treatment. Much attention has been given to preventive and curative strategies for BCRL. Patients with inflammatory breast cancer (IBC) are at particularly increased risk, with approximately half of patients with IBC developing BCRL. We present preliminary outcome data for inflammatory breast cancer patients who undergo a multipronged preventative strategy with immediate lymphatic reconstruction at the time of axillary lymph node dissection, compressive arm sleeve wearing, and occupational therapy. We also present a literature review on IBC and BCRL. Methods: A retrospective review of patients with IBC undergoing immediate lymphatic reconstruction with lymphovenous bypass at the time of axillary lymph node dissection was performed. All patients were referred to occupational therapy for establishment of care and arm sleeve fitting and had at least 12 months of follow-up. The primary outcome of interest was the development of lymphedema. Additionally, a narrative review of the literature was performed. All English language studies pertaining to BCRL in patients with IBC were considered. Results: Eighteen patients with IBC underwent immediate lymphatic reconstruction with lymphovenous bypass between April 2022 and September 2023 by three reconstructive microsurgeons. Average follow-up time was 24.4 months (range 12.5–33.9 months). All patients underwent successful lymphovenous bypass of at least 1 channel. Of the 18 patients, 3 (16.6%) developed symptoms of lymphedema, such as heaviness of the posterior arm (2/3, 67%) or edema of the forearm (1/3, 33%). No patients developed >10% change in extremity volume. Conclusions: BCRL is a debilitating and common outcome following breast surgery in patients with IBC. Immediate reconstruction with lymphovenous bypass coupled with occupational therapy and compression sleeve management may reduce the risk for BCRL in this population.