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J Reconstr Microsurg 2024; 40(04): 311-317
DOI: 10.1055/a-2182-1015
Original Article

Preoperative Risk Factors for Lymphedema in Inflammatory Breast Cancer

Libby R. Copeland-Halperin 
1   Department of Surgery, Northwell Health, New York, New York
,
Colby J. Hyland
2   Department of Surgery, Mass General Brigham, Boston, Massachusetts
,
Goutam K. Gadiraju
3   Harvard Medical School, Boston, Massachusetts
,
David H. Xiang
3   Harvard Medical School, Boston, Massachusetts
,
Jennifer R. Bellon
4   Department of Radiation Oncology, Dana–Farber Cancer Institute, Boston, Massachusetts
,
Filipa Lynce
5   Department of Medicine, Dana–Farber Cancer Institute, Boston, Massachusetts
,
Tanujit Dey
6   Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
,
Elizabeth P. Troll
7   Department of Breast Oncology, Dana–Farber Cancer Institute, Boston, Massachusetts
,
Sean J. Ryan
8   Department of Medical Oncology, Dana–Farber Cancer Institute, Boston, Massachusetts
,
Faina Nakhlis
6   Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
,
Justin M. Broyles
6   Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
› Author Affiliations Funding None.
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Abstract

Background Prophylactic lymphatic bypass or LYMPHA (LYmphatic Microsurgical Preventive Healing Approach) is increasingly offered to prevent lymphedema following breast cancer treatment, which develops in up to 47% of patients. Previous studies focused on intraoperative and postoperative lymphedema risk factors, which are often unknown preoperatively when the decision to perform LYMPHA is made. This study aims to identify preoperative lymphedema risk factors in the high-risk inflammatory breast cancer (IBC) population.

Methods Retrospective review of our institution's IBC program database was conducted. The primary outcome was self-reported lymphedema development. Multivariable logistic regression analysis was performed to identify preoperative lymphedema risk factors, while controlling for number of lymph nodes removed during axillary lymph node dissection (ALND), number of positive lymph nodes, residual disease on pathology, and need for adjuvant chemotherapy.

Results Of 356 patients with IBC, 134 (mean age: 51 years, range: 22–89 years) had complete data. All 134 patients underwent surgery and radiation. Forty-seven percent of all 356 patients (167/356) developed lymphedema. Obesity (body mass index > 30) (odds ratio [OR]: 2.7, confidence interval [CI]: 1.2–6.4, p = 0.02) and non-white race (OR: 4.5, CI: 1.2–23, p = 0.04) were preoperative lymphedema risk factors.

Conclusion Patients with IBC are high risk for developing lymphedema due to the need for ALND, radiation, and neoadjuvant chemotherapy. This study also identified non-white race and obesity as risk factors. Larger prospective studies should evaluate potential racial disparities in lymphedema development. Due to the high prevalence of lymphedema, LYMPHA should be considered for all patients with IBC.

Keywords

lymphedema - inflammatory breast cancer - breast cancer treatment

Meetings

Data from this manuscript have or will be presented at the 2023 American Society of Reconstructive Microsurgery meeting (Aventura, FL), 2023 Plastic Surgery Research Council meeting (Cleveland, OH), and 2023 American Association of Plastic Surgeons annual meeting (Chicago, IL).




Publication History

Received: 30 April 2023

Accepted: 18 September 2023

Accepted Manuscript online:
26 September 2023

Article published online:
01 November 2023

© 2023. Thieme. All rights reserved.

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