One Surgery, Two Solutions: A Systematic Review of Combined Autologous Breast Reconstruction and Lymphatic Surgery

Simultaneous autologous breast reconstruction (ABR) and lymphatic surgery has emerged as a strategy to address breast cancer-related lymphedema (BCRL) while restoring breast contour within a single operative procedure. In light of the diversity of surgical strategies, we aimed to evaluate the current literature on combined ABR and lymphatic surgery, with particular focus on surgical techniques, clinical outcomes, complications, and patient-reported satisfaction. A systematic review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420251135446). Medline, Embase, CENTRAL, Web of Science, and PubMed were searched through 9 January 2026 Studies reporting outcomes of simultaneous ABR and lymphatic reconstruction were included. Data on surgical techniques, complications, changes in limb volume and cellulitis incidence, and patient-reported outcomes were extracted. Twenty-seven studies including 499 patients (mean follow-up 23 months) were analyzed. The most common approach was a chimeric deep inferior epigastric perforator (DIEP) flap with inguinal lymph nodes (459 patients), followed by ABR with a separate vascularized lymph node transfer and ABR with lymphovenous anastomosis. Most studies reported postoperative reductions in limb volume and cellulitis, with cellulitis reduction rates up to 100%. Patient-reported outcomes (LYMQOL, ULL-27, LYMPH-Q) showed improved quality of life. Complication rates were low, including 4% seroma and 1% flap loss after chimeric DIEP. Simultaneous ABR and lymphatic reconstruction is feasible and associated with improved clinical and patient-reported outcomes. However, heterogeneity limits comparison between the different surgical techniques, and prospective studies with standardized outcomes measurements are needed.