Incorporating Lymphedema Reconstruction into Breast Reconstruction: Concepts, Approach, and Systematic Review.

Area of Science:

• Oncology
• Microsurgery
• Lymphedema Management

Background:

• Breast cancer-related lymphedema (BCRL) frequently follows axillary lymph node dissection (ALND) and radiotherapy (RT).
• Advancements in reconstructive microsurgery enable integrating lymphatic procedures into breast cancer treatment pathways for prevention and therapy.

Purpose of the Study:

• To systematically review current concepts, techniques, and evidence for integrated breast and lymphatic reconstruction.
• To synthesize findings on preventive and therapeutic lymphatic surgery in breast cancer patients.

Main Methods:

• Systematic review of PubMed and Web of Science from inception to December 27, 2025.
• Inclusion of 89 studies (RCTs, cohort studies, case series) on lymphatic surgery integrated with breast cancer treatment.
• Analysis of preventive (immediate lymphatic reconstruction/LYMPHA) and therapeutic (vascularized lymph node transfer/VLNT) strategies.

Main Results:

• Two integration paradigms: preventive (immediate lymphatic reconstruction at ALND) and therapeutic (VLNT with autologous breast reconstruction/TBAR).
• Preventive strategies show feasibility and evolving evidence for risk reduction; therapeutic VLNT reports favorable limb volume and quality of life.
• Implementation studies identify access barriers; economic analyses suggest cost-effectiveness for ILR in high-risk groups.

Conclusions:

• BCRL management is shifting towards integrated, continuum-based interventions.
• Preventive immediate lymphatic reconstruction and reconstructive VLNT/TBAR strategies are key evolving approaches.
• Further research needed on standardized outcomes, long-term follow-up (especially with RT), and implementation for equitable adoption.