Evaluating the Safety of Immediate Lymphatic Reconstruction With Implant-Based Breast Reconstruction: Eight-Year Institutional Review

Abstract

Background

Lymphedema is a chronic condition that can occur in patients following axillary lymph node dissection (ALND). Breast reconstruction has been reported to reduce lymphedema risk. When immediate lymphatic reconstruction (ILR) is combined with implant-based breast reconstruction (IBR), it offers the potential for both functional and esthetic benefits in one surgery. However, its impact on postoperative complications, such as infection and wound dehiscence, among others, remains underexplored.

Methods

An IRB-approved retrospective review was conducted on patients who underwent ALND and immediate implant reconstruction (IBR). Data collected included patient demographics, treatment characteristics, and complication rates. Assessed complications included major infection requiring intravenous antibiotic or reoperation, minor infection requiring oral antibiotic, hematoma, seroma, wound issues, deep vein thrombosis, mastectomy flap necrosis, reoperation, implant explantation, and rehospitalization. The primary outcome was a comparison of complication rates between patients who received ILR and those who did not.

Results

The study included 178 patients (68 with ILR and 110 without ILR), accounting for implant reconstruction in 266 breasts. Mean operative time was significantly longer in the ILR group (326 min vs. 245, p < 0.001). Despite this, overall complication rates were comparable (38% vs. 34%, p = 0.63). No significant differences were observed in infection rates, seroma formation, reoperations, or implant explantations over a three-year follow-up period. Age and BMI were identified as independent predictors of complications.

Conclusions

Despite longer operative times, ILR demonstrates a comparable safety profile to implant-based breast reconstruction when performed concurrently following ALND.