Safety and Operative Burden of Immediate Lymphatic Reconstruction During Breast Cancer Surgery With Concurrent Breast Reconstruction: A 13‐Year ACS‐NSQIP Analysis

BACKGROUND: Immediate lymphatic reconstruction (ILR) is increasingly performed during axillary lymph node dissection to reduce breast cancer-related lymphedema. Prior national studies evaluated broader ALND populations, while the perioperative safety and operative-duration profile of ILR specifically during concurrent breast reconstruction remains incompletely defined. We evaluated 30-day safety and total operative duration associated with ILR in women undergoing breast cancer surgery with concurrent reconstruction. METHODS: We performed a retrospective cohort study using ACS-NSQIP data from 2012 to 2024. Adult women with breast malignancy undergoing breast extirpative surgery with same-encounter implant-based or autologous reconstruction were included. ILR was identified using a published CPT-based algorithm. The primary outcome was any 30-day postoperative complication. Secondary outcomes included wound complications, surgical-site infection (SSI), return to the operating room, readmission, operative time, and length of stay. Temporal efficiency was assessed using an ILR-by-year interaction. RESULTS: Among 65,437 women, 367 (0.56%) underwent ILR. Use increased from 0.03% in 2012 to 1.57% in 2024. Documented ALND was present in 72.2% of ILR recipients and 18.7% of nonrecipients. ILR was not associated with any 30-day complication (adjusted odds ratio [aOR] = 0.98; 95% CI = 0.71-1.35; p = 0.898), wound complications (aOR = 1.11; 95% CI = 0.75-1.65; p = 0.597), SSI (aOR = 0.88; 95% CI = 0.56-1.40; p = 0.600), return to the operating room (aOR = 0.92; 95% CI = 0.62-1.37; p = 0.681), or readmission (aOR = 1.05; 95% CI = 0.65-1.70; p = 0.834). ILR was associated with a 90.4-min longer total operative duration (95% CI = 80.1-100.6; p < 0.001), without a difference in postoperative length of stay (adjusted mean difference, 0.03 days; 95% CI = -0.21 to 0.26; p = 0.832). The operative-duration difference did not attenuate over time (interaction = 0.44 min/year; 95% CI = -2.89 to 3.78; p = 0.796). CONCLUSIONS: ILR was not associated with increased adjusted 30-day morbidity but was associated with longer total operative duration. These findings support short-term perioperative safety in patients undergoing concurrent reconstruction but do not establish long-term effectiveness in preventing breast cancer-related lymphedema.