Lymphedema of the Breast Following Partial Mastectomy and Oncoplastic Reduction

Breast lymphedema is characterized by skin thickening/swelling of the breast and is common following partial mastectomy and radiation. Oncoplastic reduction performed during partial mastectomy removes additional breast tissue compared to partial mastectomy alone to optimize breast contour. Recent literature has suggested oncoplastic reduction in patients with macromastia undergoing breast-conservation surgery is protective of breast lymphedema, decreasing rates from 11% to 3%. The purpose of this study is to assess the rates of breast lymphedema after partial mastectomy and oncoplastic reduction and identify risk factors. A single-center retrospective study was performed of breast cancer patients following partial mastectomy and oncoplastic reduction (2018-2023). Patients underwent contralateral breast reduction for symmetry. Breast lymphedema was assessed. Demographics data and risk factors were evaluated. This study included 158 patients who underwent partial mastectomy and oncoplastic reduction. Breast lymphedema incidence was 3.2% (5/158). Including contralateral non-cancerous breast symmetry reduction, lymphedema occurred in 3.6% (5/140) of irradiated breasts and 0% (0/176) of non-irradiated breasts (p = 0.0164). Among irradiated breasts, skin necrosis occurred in 11.4% (16/140) compared to 4.5% (8/176) of non-irradiated breasts (p = 0.031). Breast lymphedema developed 207.4 ± 37.6 days postoperatively and 101.6 ± 15.9 days following adjuvant radiation. Mean follow-up was 639 days. Breast lymphedema incidence following partial mastectomy and oncoplastic reduction was 3.6% in this series and occurs 3-4 months after radiation. Radiation was the only significant risk factor for developing breast lymphedema. This largest series on breast lymphedema after oncoplastic reduction corroborates that oncoplastic reduction may be protective.