Prospective 2 Year Review of Lymphedema Rates in Breast Cancer Patients Following Mastectomy, Axillary Clearance, and Immediate Free Flap Breast Reconstruction.

The reported incidence of lymphedema varies greatly among women treated for breast cancer, making counselling for surgery challenging. This study assessed the incidence of lymphedema in patients undergoing mastectomy and free flap reconstruction using robust, quantifiable, and replicable diagnostic criteria. Data on limb circumference, limb volume, and reported symptoms was collected prospectively pre-operatively, post operatively, and at 2 years. All patients undergoing skin sparing mastectomy with axillary node clearance and immediate free tissue breast reconstruction between 2009 and 2018 were included. We followed 113 patients to 2-year follow-up. The prevalence of patients meeting two identifying criteria was highest in the immediate post-operative period at 11%, falling to 4% at 2 years. The proportion of patients meeting three criteria remained static from the post-operative period to two years at 7%, though the incidence declined over that period. All the patients with three identifying criteria post-operatively and at two years had received either chemotherapy or chemotherapy and radiotherapy. Clear diagnostic criteria are important for the accurate assessment and study of post operative lymphedema. It is possible that free tissue transfer could reduce the incidence of or delays the onset of lymphedema in patients undergoing mastectomy and axillary clearance.