Breast reconstruction and risk of arm lymphedema development: A meta-analysis

Charalampos Siotos, Mohamad E. Sebai, Eric L. Wan, Ricardo J. Bello, Mehran Habibi, Damon Cooney, Michele Manahan, Carisa Miller Cooney, Stella M. Seal, Gedge David Rosson

Research output: Contribution to journalArticle

Abstract

Background: Lymphedema remains a significant complication following breast cancer surgery when there is axillary lymph node intervention. Previous systematic reviews have identified risk factors for breast cancer-related lymphedema, including increased BMI, number of lymph nodes dissected and radiotherapy. However, they have not examined the effect of breast reconstruction on lymphedema occurrence. In this systematic review and meta-analysis, we sought to evaluate the association between breast reconstruction (BR) and lymphedema. Methods: We searched PubMed (1966-2016), Embase (1966-2016), Scopus (2004-2016) and Google Scholar (2004-2016) for studies involving breast reconstruction and upper-extremity lymphedema or breast cancer-related lymphedema. Our primary outcome was lymphedema occurrence. We performed a meta-analysis using random effects due to heterogeneity of the studies. Results: Our search strategy identified 934 articles. After screening, 19 studies were included in our meta-analysis evaluating outcomes based on number of patients (7501) or number of breasts surgically treated (2063). Breast reconstruction was significantly associated with lower odds of lymphedema (p < 0.001) compared to mastectomy only or breast-conserving surgery. Lymphedema rates were not statistically significantly different between patients undergoing implant-based or autologous BR. Conclusions: Breast reconstruction is associated with lower rates of lymphedema compared to mastectomy only or breast conserving surgery patients. Although the study does not prove causation, we hypothesize that this association is likely due to multiple factors, including a self-selecting population and mechanisms through which BR may contribute to primary or secondary prevention of lymphedema. Further prospective studies are needed to clarify this beneficial relationship between breast reconstruction and reduced lymphedema risk.

Original languageEnglish (US)
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Lymphedema
Mammaplasty
Meta-Analysis
Arm
Segmental Mastectomy
Mastectomy
Lymph Nodes
Primary Prevention
Secondary Prevention
PubMed
Upper Extremity
Causality
Breast
Radiotherapy
Prospective Studies
Breast Neoplasms

Keywords

  • Breast cancer
  • Breast reconstruction
  • Lymphedema
  • Meta-analysis
  • Upper-extremity lymphedema

ASJC Scopus subject areas

  • Surgery

Cite this

Breast reconstruction and risk of arm lymphedema development : A meta-analysis. / Siotos, Charalampos; Sebai, Mohamad E.; Wan, Eric L.; Bello, Ricardo J.; Habibi, Mehran; Cooney, Damon; Manahan, Michele; Cooney, Carisa Miller; Seal, Stella M.; Rosson, Gedge David.

In: Journal of Plastic, Reconstructive and Aesthetic Surgery, 01.01.2018.

Research output: Contribution to journalArticle

@article{17176227e33849b6bb36db4a2af22109,
title = "Breast reconstruction and risk of arm lymphedema development: A meta-analysis",
abstract = "Background: Lymphedema remains a significant complication following breast cancer surgery when there is axillary lymph node intervention. Previous systematic reviews have identified risk factors for breast cancer-related lymphedema, including increased BMI, number of lymph nodes dissected and radiotherapy. However, they have not examined the effect of breast reconstruction on lymphedema occurrence. In this systematic review and meta-analysis, we sought to evaluate the association between breast reconstruction (BR) and lymphedema. Methods: We searched PubMed (1966-2016), Embase (1966-2016), Scopus (2004-2016) and Google Scholar (2004-2016) for studies involving breast reconstruction and upper-extremity lymphedema or breast cancer-related lymphedema. Our primary outcome was lymphedema occurrence. We performed a meta-analysis using random effects due to heterogeneity of the studies. Results: Our search strategy identified 934 articles. After screening, 19 studies were included in our meta-analysis evaluating outcomes based on number of patients (7501) or number of breasts surgically treated (2063). Breast reconstruction was significantly associated with lower odds of lymphedema (p < 0.001) compared to mastectomy only or breast-conserving surgery. Lymphedema rates were not statistically significantly different between patients undergoing implant-based or autologous BR. Conclusions: Breast reconstruction is associated with lower rates of lymphedema compared to mastectomy only or breast conserving surgery patients. Although the study does not prove causation, we hypothesize that this association is likely due to multiple factors, including a self-selecting population and mechanisms through which BR may contribute to primary or secondary prevention of lymphedema. Further prospective studies are needed to clarify this beneficial relationship between breast reconstruction and reduced lymphedema risk.",
keywords = "Breast cancer, Breast reconstruction, Lymphedema, Meta-analysis, Upper-extremity lymphedema",
author = "Charalampos Siotos and Sebai, {Mohamad E.} and Wan, {Eric L.} and Bello, {Ricardo J.} and Mehran Habibi and Damon Cooney and Michele Manahan and Cooney, {Carisa Miller} and Seal, {Stella M.} and Rosson, {Gedge David}",
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T1 - Breast reconstruction and risk of arm lymphedema development

T2 - A meta-analysis

AU - Siotos, Charalampos

AU - Sebai, Mohamad E.

AU - Wan, Eric L.

AU - Bello, Ricardo J.

AU - Habibi, Mehran

AU - Cooney, Damon

AU - Manahan, Michele

AU - Cooney, Carisa Miller

AU - Seal, Stella M.

AU - Rosson, Gedge David

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Lymphedema remains a significant complication following breast cancer surgery when there is axillary lymph node intervention. Previous systematic reviews have identified risk factors for breast cancer-related lymphedema, including increased BMI, number of lymph nodes dissected and radiotherapy. However, they have not examined the effect of breast reconstruction on lymphedema occurrence. In this systematic review and meta-analysis, we sought to evaluate the association between breast reconstruction (BR) and lymphedema. Methods: We searched PubMed (1966-2016), Embase (1966-2016), Scopus (2004-2016) and Google Scholar (2004-2016) for studies involving breast reconstruction and upper-extremity lymphedema or breast cancer-related lymphedema. Our primary outcome was lymphedema occurrence. We performed a meta-analysis using random effects due to heterogeneity of the studies. Results: Our search strategy identified 934 articles. After screening, 19 studies were included in our meta-analysis evaluating outcomes based on number of patients (7501) or number of breasts surgically treated (2063). Breast reconstruction was significantly associated with lower odds of lymphedema (p < 0.001) compared to mastectomy only or breast-conserving surgery. Lymphedema rates were not statistically significantly different between patients undergoing implant-based or autologous BR. Conclusions: Breast reconstruction is associated with lower rates of lymphedema compared to mastectomy only or breast conserving surgery patients. Although the study does not prove causation, we hypothesize that this association is likely due to multiple factors, including a self-selecting population and mechanisms through which BR may contribute to primary or secondary prevention of lymphedema. Further prospective studies are needed to clarify this beneficial relationship between breast reconstruction and reduced lymphedema risk.

AB - Background: Lymphedema remains a significant complication following breast cancer surgery when there is axillary lymph node intervention. Previous systematic reviews have identified risk factors for breast cancer-related lymphedema, including increased BMI, number of lymph nodes dissected and radiotherapy. However, they have not examined the effect of breast reconstruction on lymphedema occurrence. In this systematic review and meta-analysis, we sought to evaluate the association between breast reconstruction (BR) and lymphedema. Methods: We searched PubMed (1966-2016), Embase (1966-2016), Scopus (2004-2016) and Google Scholar (2004-2016) for studies involving breast reconstruction and upper-extremity lymphedema or breast cancer-related lymphedema. Our primary outcome was lymphedema occurrence. We performed a meta-analysis using random effects due to heterogeneity of the studies. Results: Our search strategy identified 934 articles. After screening, 19 studies were included in our meta-analysis evaluating outcomes based on number of patients (7501) or number of breasts surgically treated (2063). Breast reconstruction was significantly associated with lower odds of lymphedema (p < 0.001) compared to mastectomy only or breast-conserving surgery. Lymphedema rates were not statistically significantly different between patients undergoing implant-based or autologous BR. Conclusions: Breast reconstruction is associated with lower rates of lymphedema compared to mastectomy only or breast conserving surgery patients. Although the study does not prove causation, we hypothesize that this association is likely due to multiple factors, including a self-selecting population and mechanisms through which BR may contribute to primary or secondary prevention of lymphedema. Further prospective studies are needed to clarify this beneficial relationship between breast reconstruction and reduced lymphedema risk.

KW - Breast cancer

KW - Breast reconstruction

KW - Lymphedema

KW - Meta-analysis

KW - Upper-extremity lymphedema

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