The Patient's Perspective on the Effect of Autologous Breast Reconstruction on Lymphedema

Lymphedema is a well-documented complication of the treatment for breast cancer. Although the onset of lymphedema is rare after delayed autologous breast reconstruction, no studies have surveyed a patient's perspective on the effects of reconstruction on lymphedema.

The design of this study was a retrospective review of delayed unilateral breast reconstruction performed by the senior authors between 2005 and 2009 combined with the use of a well-validated survey instrument that can be used to diagnose lymphedema. Patients were mailed a series of questions to determine if they had lymphedema. In addition, they were asked separate questions about reconstruction's effect on arm symptoms.

During this period, 90 patients underwent delayed unilateral breast reconstruction with an autologous free flap. After 2 mailings, 68.8% (n = 62) of patients returned the survey and were included in data analysis. Of the 62 respondents, 11.3% (n = 7) had been diagnosed and documented as having lymphedema in the medical record. This is in stark contrast to the survey that reported 48.3% (n = 30) with lymphedema (P < 0.01), which is more consistent with previous reports of lymphedema after mastectomy. Overall, 29.0% (n = 18) reported mild lymphedema and 20.0% (n = 12) reported moderate/severe lymphedema. Of those diagnosed by survey, 51.7% thought there was no change, 27.6% were worse, and 20.7% were better after reconstruction. Although not necessarily indicative of a diagnosis of lymphedema, when asked questions about arm symptoms, 38.4% thought their symptoms were worse, 30.8% reported no change, and 30.8% stated they were better. Of those patients with lymphedema by survey, only 18.5% reported discussing this with their plastic surgeon.

Overall, the prevalence of lymphedema was similar to published reports in the cancer literature, but much more common than reported in our plastic surgery clinic or recent plastic surgery literature. On the whole, delayed reconstruction seems to have no effect on lymphedema. Although more prospective study is necessary to answer this question conclusively, as part of a multidisciplinary team, plastic surgeons should be aware that lymphedema is common; patients may not volunteer their symptoms and may in fact benefit from specific questioning to aid in diagnosis and treatment.