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Immediate Lymphatic Reconstruction with Implant-Based Breast Reconstruction: A Study of Postoperative Complications
Diwakar Phuyal, MBBS; Fuad Abbas, BS; Osama Darras, MD; Zoe E. Belardo, BA; Risal Djohan, MD; Steven L Bernard, MD; Graham Schwarz, MD, MSE, FACS; Raffi Gurunian MD PhD; Sarah N Bishop MD
Cleveland Clinic Foundation
2025-01-10
Presenter: Diwakar Phuyal
Affidavit:
Yes
Director Name: Raymond Isakov
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Abstract
Background:
Lymphedema can occur in patients requiring axillary lymph node dissection (ALND). Breast reconstruction may reduce lymphedema risk. When immediate lymphatic reconstruction (ILR) is combined with IBR, it offers potential for both functional and aesthetic benefits in a single surgery. However, the impact of additional procedure on postoperative complications remains underexplored.
Methods:
A retrospective review was conducted on patients who underwent ALND and immediate implant reconstruction. Two groups included patients with immediate breast reconstruction with axillary lymph node dissection with (ILR) or without ILR (nonILR). Patients' demographics and complication rates were compared between two groups.
Results:
41 patients included in ILR group and 85 patients in non ILR group. No significant differences were observed in the demographics of patients between the ILR and non-ILR groups. Patients in the ILR group underwent radiation therapy and chemotherapy significantly more often (100% vs. 75.3%, p=0.001; 95.1% vs. 71.8%, p=0.002, respectively). Operative time was longer in the ILR group (333.4 minutes vs. 247.9 minutes, p<0.001). Overall complication rates (39% vs. 25.3%, p=0.69) and follow-up duration were not significantly different. Complications such as infection, hematoma, seroma, wound issues, implant exposure, and reoperation rates were also similar between the groups.
Conclusions:
Immediate lymphatic reconstruction with implant-based breast reconstruction does not significantly increase complications, rehospitalizations, or implant explanation rates. Despite longer operative times, the overall safety profile is comparable, supporting ILR as a feasible option for ALND patients.
