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Updated: May 7, 2025

Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
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A Single Institution Experience With Immediate Lymphatic Reconstruction: Impact of Insurance Coverage on Risk

Anne Huang1, Emma Koesters1, Rebecca M Garza2

  • 1Section of Plastic and Reconstructive Surgery, University of Chicago Medicine & Biological Sciences, Chicago, Illinois, USA.

Journal of Surgical Oncology
|December 30, 2024
PubMed
Summary
This summary is machine-generated.

Immediate lymphatic reconstruction (ILR) access is limited by insurance disparities, affecting breast cancer patients. Financial barriers prevent indicated ILR, potentially worsening lymphedema outcomes.

Keywords:
LYMPHAbreast cancer related lymphedemaimmediate lymphatic reconstructionlymphovenous bypass

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Lymphedema Research

Background:

  • Immediate lymphatic reconstruction (ILR) is a procedure to prevent breast cancer-related lymphedema.
  • Insurance coverage for ILR is inconsistent in the United States.
  • Patients with clinical axillary lymph node involvement are candidates for ILR.

Purpose of the Study:

  • To evaluate the impact of insurance coverage and financial resources on access to ILR.
  • To assess the outcomes of ILR in preventing lymphedema.
  • To identify disparities in ILR access and outcomes.

Main Methods:

  • Retrospective review of a prospective database of ILR candidates (2018-2022).
  • Analysis of patient demographics, insurance type, and lymphedema development.
  • Comparison of outcomes between patients who underwent ILR, did not undergo ILR when indicated, and had no indication for ILR.

Main Results:

  • 50 out of 180 ILR candidates underwent the procedure.
  • Patients not receiving ILR were more likely to be Black, have Medicaid, and have lower incomes.
  • Financial reasons accounted for 55% of cases where indicated ILR was not performed.
  • Lymphedema rates were 14.6% (ILR), 12.5% (no indication), and 40% (indicated but not performed).

Conclusions:

  • Disparities in insurance coverage and financial resources negatively affect access to ILR.
  • Lack of access to indicated ILR is associated with higher rates of lymphedema.
  • Addressing financial barriers is crucial for equitable lymphedema prevention in breast cancer patients.