Lymphedema is a chronic condition that afflicts up to 30% of women treated for breast cancer. Damage to a patient’s lymphatic system via lymph node removal and/or irradiation during cancer treatment can cause inadequate lymphatic fluid clearance, and the chronic swelling characteristic of lymphedema. Given that breast reconstructive surgery post-mastectomy causes further local tissue damage and disruption, one might hypothesize that reconstructive surgery may increase the risk of lymphedema. In fact, the inverse may be true… sort of…
According to the studies conducted to date, undergoing reconstructive surgery post-mastectomy does not appear to be associated with an increased risk of lymphedema. But could it actually be associated with a decreased risk of developing lymphedema? Early observations have suggested that this could be the case, but with little empirical evidence to support it. A paper published last week (Card, A., Crosby M.A., et al. Plast Reconstr Surg. 2012 Epub Aug 8) provides stronger evidence. By following 1090 women who had undergone either mastectomy alone or mastectomy with immediate breast reconstruction, the authors observed both a delay in the onset of lymphedema, as well as a decrease in the total incidence of lymphedema over an average of 5 years.
So what’s going on here?
The authors of the paper suggest the possibility that reconstructive surgery may offer some sort of protective effect, although the exact mechanism remains unclear. Introducing healthy vascularized tissue during reconstructive surgery may promote lymphatic regeneration, or create bridges to damaged lymphatic vessels. An alternative hypothesis is that breast reconstructive surgery is not in itself protective, but is instead correlated with good health or other good behaviours that provide a protective effect. In other words, people who choose to undergo reconstructive surgery may tend towards healthier choices, or generally be in better health than those who choose not to. For example, the authors note that people who chose to undergo reconstructive surgery in this study had significantly lower rates of smoking, hypertension, diabetes and obesity. There is a known link between obesity and lymphedema that could potentially explain this phenomenon, however, using a statistical approach the authors concluded that the relationship between breast reconstruction and a decreased incidence of lymphedema would likely still exist even after removing obesity as a factor.
So what should we take away from this?
Breast reconstruction post-mastectomy remains a personal choice. Thankfully it does not appear to be associated with an increased risk of lymphedema, but nor is there sufficient evidence that it imparts a protective effect. This study is a good reminder that your personal risk of developing lymphedema is not the same as someone else’s – it’s at least partially dependent upon the decisions that you make. For all individuals at risk of lymphedema, good health and fitness, weight management, and keen surveillance for early signs of lymphedema are your best strategies to minimize your risk.