Background: Breast cancer related lymphedema (BRCL) is a potential sequelae of high risk breast cancer treatment. Preventative treatment with immediate lymphatic reconstruction (ILR) at the time of axillary lymph node dissection(ALND) has emerged as the standard of care, however there is relatively little known about the impact of cancer stage on outcomes.

Methods: A retrospectively maintained, IRB approved study followed patients who underwent ILR at the time of ALND at our tertiary care center between May 2018 to present day. Patients who presented for 2 years of follow up in our multidisciplinary lymphedema clinic met criteria for inclusion. Patients who developed lymphedema despite ILR and contributing factors were explored.

Results: 372 patients underwent ILR at our institution between May 2018 and present day. 236 of these patients have presented for long term follow up in our multidisciplinary lymphedema clinic. 28 (11.9%) patients developed lymphedema despite ILR. There was no significant difference in cancer staging (T/N/M) between patients who developed lymphedema and those that did not.  Multivariate logistic regression demonstrates no increased risk of lymphedema with advanced disease (T: OR=1.09 (0.75-1.59) p=0.66, N: OR 1.11 (0.74-1.66), p=0.63, M: OR=1.00 (0.73-5.37), p=0.18).

Conclusion: This data comment upon our institutions outcomes following ILR. Patients who develop lymphedema despite ILR did not significantly differ in respect to cancer stage, and logistic regression demonstrates more advanced disease alone does not place patients at higher risk for developing BCRL following ILR.  Consideration of this data is important for preprocedural counselling and reassuring from a practice standpoint.