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Updated: May 29, 2026

A Murine Tail Lymphedema Model
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Is Immediate Lymphatic Reconstruction Cost-Effective for Breast Cancer Lymphedema?

Erica N Onuoha1, Shayan M Sarrami2, Kenneth J Smith3

  • 1University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA 15213.

Plastic and Reconstructive Surgery
|May 27, 2026
PubMed
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Preventing breast cancer lymphedema after axillary lymph node dissection (ALND) is achievable. Both immediate lymphatic reconstruction (ILR) and prospective surveillance are cost-effective, with ILR offering the most significant health benefits.

Area of Science:

  • Oncology
  • Microsurgery
  • Health Economics

Background:

  • Lymphedema is a common, debilitating complication after breast cancer treatment involving axillary lymph node dissection (ALND) and radiation.
  • This condition causes significant long-term morbidity and economic burden, necessitating effective prevention strategies.

Purpose of the Study:

  • To evaluate the cost-effectiveness of different lymphedema prevention strategies following ALND in breast cancer patients.
  • To compare immediate lymphatic reconstruction (ILR) and prospective surveillance against no intervention.

Main Methods:

  • A model-based cost-effectiveness analysis was performed from a payer perspective using a decision tree.
  • Patients were stratified into oncologic treatment cohorts; a 45-year-old with stage III breast cancer undergoing ALND was the base case.

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  • Outcomes measured included costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs).

    • Main Results:

    • Both prospective surveillance (ICER: $344/QALY) and ILR (ICER: $1,607/QALY) were found to be cost-effective compared to no intervention.
    • No intervention was cheapest ($10,774) but least effective (17.94 QALYs).
    • ILR provided the highest health benefit (22.35 QALYs) at the highest cost ($15,426), with an ICER below the willingness-to-pay threshold.

    Conclusions:

    • Immediate lymphatic reconstruction (ILR) and prospective surveillance are cost-effective lymphedema prevention strategies post-ALND.
    • ILR provides maximal health benefits and supports integrating preventive microsurgery into breast cancer care.