Top Line: Does the technique of immediate breast reconstruction after mastectomy impact the risk of lymphedema?
The Study: This Korean retrospective review of 664 women undergoing mastectomy with immediate reconstruction for breast cancer demonstrates, despite being associated with a higher rate of full axillary dissection, a latissimus dorsi flap had by far the lowest rate of lymphedema at 5 years (3.7%) when compared to an abdominal flap (10.6%) or implant-based (10.9%) reconstructions. This remained the case on multivariate analyses including patient BMI, receipt of adjuvant therapies, and cancer staging and is consistent with other small observational series. Now, conjectures as to why are fascinating. “It appears that the muscle flap transferred into the region with impaired lymphatic flow may be helpful in reestablishing lymphatic continuity, or at least providing a favorable environment for lymphatic flow restoration.” In other words, when the latissimus dorsi is severed from its insertion into the humeral head and secured as a pedicle in the dissected axillary region, it can remarkably act as a “lymphatic bridge” with its own native lymph nodes traversing an otherwise impaired upper extremity to trunk.
TBL: In this retrospective study, immediate reconstruction with a latissimus flap was associated with a lower risk of lymphedema than expander/implant or abdominal flap reconstruction. | Lee, Eur J Sur Oncol 2023
The Study: This Korean retrospective review of 664 women undergoing mastectomy with immediate reconstruction for breast cancer demonstrates, despite being associated with a higher rate of full axillary dissection, a latissimus dorsi flap had by far the lowest rate of lymphedema at 5 years (3.7%) when compared to an abdominal flap (10.6%) or implant-based (10.9%) reconstructions. This remained the case on multivariate analyses including patient BMI, receipt of adjuvant therapies, and cancer staging and is consistent with other small observational series. Now, conjectures as to why are fascinating. “It appears that the muscle flap transferred into the region with impaired lymphatic flow may be helpful in reestablishing lymphatic continuity, or at least providing a favorable environment for lymphatic flow restoration.” In other words, when the latissimus dorsi is severed from its insertion into the humeral head and secured as a pedicle in the dissected axillary region, it can remarkably act as a “lymphatic bridge” with its own native lymph nodes traversing an otherwise impaired upper extremity to trunk.
TBL: In this retrospective study, immediate reconstruction with a latissimus flap was associated with a lower risk of lymphedema than expander/implant or abdominal flap reconstruction. | Lee, Eur J Sur Oncol 2023