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Reconstruction increases lymphedema risk?

Page last modified on: September 18, 2008
Question from Chris: I am small-breasted (34 B) and had a left-sided mastectomy 11 months ago. My oncologists think that there is the possibility of some remaining breast tissue that should be removed. It makes sense to do reconstruction at the same time. TRAM vs. implants vs. nothing? Does additional surgery increase the chance of lymphedema? Psychologically, do women do better with reconstruction? Is it unusual to be so confused?
Answers —Maurice Nahabedian, M.D.: It's not unusual to be confused, primarily because there are so many decisions, and complicated ones, to be made. As far as requiring secondary procedures, the risk of lymphedema can increase if those procedures involve structures near the lymph node basin in the armpit. As the number of lymph nodes that are removed increases, or as scar tissue that develops near those lymph nodes increases, the risk of lymphedema will increase. This generally ranges at about 20% for women who've had most of the lymph nodes removed from the armpit area.
Marisa Weiss, M.D., president and founder: The bottom level (level I) of the underarm lymph nodes live right next to and beneath the top of the breast area. Surgery to the breast and to the lymph nodes overlaps in this region and can affect the fluid retention around the soft tissues in the armpit and in the breast area. Radiation to the breast area can increase fluid and, often, lymph fluid in the area of the breast and armpit as well, separate from "lymphedema" or swelling of the arm.

On Wednesday, November 19, 2003, our Ask-the-Expert Online Conference was called Breast Reconstruction. Maurice Nahabedian, M.D. and Marisa Weiss, M.D. answered your questions about different techniques in breast reconstruction, the pros and cons of implants and body tissue transfers, when you might want to reconstruct, and many more issues related to rebuilding your breast/s after breast cancer surgery.

The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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Meet the Experts

Maurice Nahabedian, M.D. is director of the Center of Reconstructive and Aesthetic Surgery of the Breast and associate professor of plastic Surgery at Johns Hopkins.

Marisa Weiss, M.D. is a radiation oncologist specializing in breast cancer and the founder, president, and guiding force behind Breastcancer.org.

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