The impact of breast reconstruction compared with no reconstruction on breast cancer-related lymphedema: A systematic review and meta-analysis

Breast cancer-related lymphedema affects 21.9% of patients. The role of breast reconstruction in lymphedema prevention remains unclear. This review aimed to assess the relative risk of breast cancer-related lymphedema after breast reconstruction compared with mastectomy and breast-conserving surgery, which has thus far been inconclusively assessed. We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. PubMed, EMBASE, Cochrane Central, and gray literature searches identified studies reporting lymphedema outcomes after mastectomy, breast-conserving surgery, and breast reconstruction. We calculated incidence rate ratios using random-effects models. Subgroup analyses compared reconstruction timing (immediate compared with delayed), types (autologous compared with implant-based), and immediate implant stages (1-stage compared with 2-stage). Twenty-three studies with 15,670 patients were included in the qualitative analysis, and 14 were included in the meta-analysis. Patients with breast reconstruction had a significantly lower risk of lymphedema than those without reconstruction (incidence rate ratio, 0.58; 95% confidence interval, 0.38-0.87, P < .001). However, this effect was less pronounced when only studies with baseline lymphedema measurements were included. We found no significant differences between autologous and implant-based reconstructions, immediate and delayed reconstruction, or 1- and 2-stage implant-based reconstruction. Breast reconstruction does not increase the risk for breast cancer-related lymphedema, and the risk of lymphedema is similar across different types of breast reconstruction. Breast reconstruction may reduce the risk of breast cancer-related lymphedema compared with mastectomy alone. The lack of baseline lymphedema measurements in most studies and studies with follow-up less than 4 years limits the strength of these findings.