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Updated: May 13, 2025

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Axillary Lymph Node Dissection With and Without Immediate Lymphatic Reconstruction: Association With Drain Days and

Samantha J Brown1, Sarah A McLaughlin2, Judy C Boughey3

  • 1Mayo Clinic Alix School of Medicine, Jacksonville, FL, USA.

The American Surgeon
|April 15, 2025
PubMed
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Immediate lymphatic reconstruction (ILR) after axillary lymph node dissection (ALND) for breast cancer did not reduce drain days. However, ILR lowered seroma incidence without increasing infection risk.

Area of Science:

  • Oncology
  • Surgical Oncology
  • Lymphedema Research

Background:

  • Axillary lymph node dissection (ALND) for breast cancer can lead to lymphedema.
  • Immediate lymphatic reconstruction (ILR) via lymphovenous anastomosis aims to mitigate this risk.
  • Drains are used post-ALND to prevent seromas, but prolonged drain use increases infection risk.

Purpose of the Study:

  • To evaluate the impact of ILR on the number of postoperative drain days following ALND in breast cancer patients.
  • To assess the effect of ILR on seroma and infection rates after ALND.

Main Methods:

  • Post-hoc analysis of a prospective trial comparing ALND with ILR versus ALND alone.
  • Statistical analysis included Wilcoxon rank sum test, chi-squared/Fisher's exact tests, and multivariable quantile regression.
Keywords:
LYMPHAbreast cancerbreast cancer-related lymphedema (BCRL)lymphaticovenous anastomosislymphovenous bypasssurgical site infection

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  • Data from 214 breast cancer patients (115 intervention, 99 control) were analyzed.

    • Main Results:

    • The ILR group had a median of 15 drain days versus 11 days in the control group (P = .001).
    • No significant difference in drain days was observed when considering drain removal criteria.
    • Seroma incidence was significantly lower in the ILR group (3.5% vs 12.1%, P = .017) with no increase in infection rates.

    Conclusions:

    • Immediate lymphatic reconstruction (ILR) following ALND for breast cancer does not reduce the number of drain days.
    • ILR is associated with a lower incidence of seromas post-ALND.
    • ILR does not increase the risk of surgical site infections.