Küthe, S.W. (2013) De incidentie van lymfoedeem na primaire versus secundaire mammareconstructie na mastectomie. thesis, Medicine.
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Abstract
Background: Several previous studies have described the association between breast reconstruction and the development of lymphedema. However, most of them report the impact of delayed reconstruction on pre-existent lymphedema and the relationship between immediate breast reconstruction and the occurrence of post-mastectomy lymphedema compared with a group without breast reconstruction. Little is known about the difference in incidence of post-mastectomy lymphedema after immediate versus delayed breast reconstruction. The aim of this study was to give founded advice when breast reconstruction should be performed regarding the morbidity. Methods: A multicenter observational study was performed for breast cancer patients who underwent breast reconstruction after mastectomy between 2000 and 2012. All consecutive female who underwent breast reconstruction after (prophylactic) mastectomy because of primary breast carcinoma or BRCA gen mutation were included. The patients were categorized into two groups based on whether they underwent immediate or delayed reconstruction. With obtained data the incidence of lymphedema was assessed and compared with Fisher’s exact test. Other potential factors (age, BMI, radiotherapy, number of excised and positive lymph nodes), described in the literature, that might have influenced the development of lymphedema were also reviewed. Eventually the different types of reconstruction were analyzed. Results: This study included 430 female (522 breasts). Data regarding lymphedema could be obtained for 339 female (409 breasts). 65 breasts treated with prophylactic mastectomy were excluded. 153 breasts underwent immediate breast reconstruction and 191 delayed reconstruction. Lymphedema developed in 59 of 344 breasts (17.2%): 12 after immediate reconstruction and 47 after delayed reconstruction. This difference was significant (p < 0.001). The secondary variables radiotherapy, ≥ positive lymph nodes, number of excised lymph nodes and ALND, with or without SLND, were also significant (p < 0.001). After adjusting for confounding factors reconstruction type had no significant effect on prevalence of lymphedema (p = 0.191). Conclusion: This study shows statistically significant differences between the incidence of lymphedema after immediate and delayed reconstruction. Patients with a delayed reconstruction are at higher risk to develop lymphedema compared with immediate reconstruction. The known risk factors radiotherapy, axillary lymph node dissection, number of excised lymph nodes and number of positive lymph nodes are also associated with an increased risk for development of lymphedema.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Mouës-Vink, Dr. C.M. and Tielemans, Drs. J.F. and Afdeling Plastische Chirurgie and Medisch Centrum Leeuwarden |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:45 |
| Last Modified: | 25 Jun 2020 10:45 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/656 |
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