Long-Term Outcomes of Lymphedema After Immediate Lymphatic Reconstruction Following Axillary Lymph Node Dissection

Breast cancer-related lymphedema (BCRL) significantly affects quality-of-life after axillary lymph node dissection (ALND). Although immediate lymphatic reconstruction (ILR) may reduce BCRL incidence, its long-term outcomes and predictors remain unclear. We report long-term BCRL prevalence in patients undergoing ILR and delineate factors associated with BCRL after ILR.

We retrospectively studied consecutive patients who underwent ILR following ALND between 2017 and 2024 across six hospitals in the Indiana University network. Primary outcome was BCRL prevalence, defined as ≥ 2-cm limb difference at two contiguous points. Secondary outcomes included BCRL predictors, postoperative complications, and compression garment use.

We identified 172 patients with a mean age 50.9 ± 11.6 years, body mass index of 29.5 ± 6.9 kg/m², and follow-up time of 23.1 ± 15.2 months. Most patients (57.7%) underwent mastectomy, ALND with breast reconstruction. The median number of lymph nodes removed during ALND was 15 (interquartile range [IQR] 10.0-21.0), and median number of positive lymph nodes was 2.0 (IQR, 0.0-4.0). The cumulative BCRL incidence was 7.0% (n = 12 patients). Median time to significant limb swelling was 4.5 (IQR, 1.0-11.3) months. Fifty-five patients (32.0%) used postoperative compression garments. Breast-related complications occurred in 30.2% of patients. Black/African American patients had significantly higher lymphedema rates than White patients (18.8% vs. 4.5%, p = 0.005). In adjusted analyses, Black/African American race was an independent predictor (odds ratio [OR], 6.38; p < 0.006) of BCRL.

Immediate lymphatic reconstruction following ALND demonstrated low BCRL rates, although Black or African American patients remain at disproportionately higher risk, warranting targeted interventions and further investigation.