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Background <p>Breast cancer patients treated with axillary lymph node dissection (ALND) have an approximate 20–30% lifetime risk of developing lymphedema, with multiple factors implicated in the pathogenesis. In patients undergoing mastectomy, ALND can be performed through the mastectomy incision or through a separate axillary incision. It is unknown whether the latter causes more lymphatic disruption resulting in higher lymphedema rates. We aimed to assess whether ALND through the mastectomy incision versus a separate incision impacts rates of breast cancer-related lymphedema (BCRL).</p> Methods <p>A retrospective chart review was performed of patients who underwent mastectomy and ALND from 2017 to 2020. Patients were grouped by ALND via mastectomy or a separate incision. The primary outcome of interest was development of BCRL as defined by ICD-10 codes.</p> Results <p>A total of 1,036 patients were included; 483 via a separate axillary incision and 553 underwent ALND via the mastectomy incision. Median time to lymphedema development was 15&#xa0;months. The BCRL rates between patients who had ALND via a separate incision were not significantly different from those who had ALND via the mastectomy incision (29 vs. 30%, <i>p</i> = 0.77). Multivariable logistical regression showed patients with ALND performed through a separate incision did not have significantly greater odds of developing lymphedema compared with those with ALND performed through the mastectomy incision (odds ratio 0.89; 95% confidence interval 0.65–1.21; <i>p</i> = 0.45).</p> Conclusions <p>Patients who received ALND via a separate axillary incision as compared to the mastectomy incision do not have significantly greater rates of BCRL. Oncologic safety should be prioritized when considering lymph node retrieval technique.</p>

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Axillary Lymph Node Dissection Through a Separate Incision Does Not Increase Rates of Breast Cancer-Related Lymphedema

  • 期刊论文

  • 发表日期：

    2026年2月10日

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  • Jennifer Wang,
  • Jenny Chen,
  • Thomas Amburn,
  • Benjamin D. Wagner,
  • Andrea V. Barrio,
  • Jonas A. Nelson,
  • Audree Tadros,
  • Michelle Coriddi

摘要

Background

Breast cancer patients treated with axillary lymph node dissection (ALND) have an approximate 20–30% lifetime risk of developing lymphedema, with multiple factors implicated in the pathogenesis. In patients undergoing mastectomy, ALND can be performed through the mastectomy incision or through a separate axillary incision. It is unknown whether the latter causes more lymphatic disruption resulting in higher lymphedema rates. We aimed to assess whether ALND through the mastectomy incision versus a separate incision impacts rates of breast cancer-related lymphedema (BCRL).

Methods

A retrospective chart review was performed of patients who underwent mastectomy and ALND from 2017 to 2020. Patients were grouped by ALND via mastectomy or a separate incision. The primary outcome of interest was development of BCRL as defined by ICD-10 codes.

Results

A total of 1,036 patients were included; 483 via a separate axillary incision and 553 underwent ALND via the mastectomy incision. Median time to lymphedema development was 15 months. The BCRL rates between patients who had ALND via a separate incision were not significantly different from those who had ALND via the mastectomy incision (29 vs. 30%, p = 0.77). Multivariable logistical regression showed patients with ALND performed through a separate incision did not have significantly greater odds of developing lymphedema compared with those with ALND performed through the mastectomy incision (odds ratio 0.89; 95% confidence interval 0.65–1.21; p = 0.45).

Conclusions

Patients who received ALND via a separate axillary incision as compared to the mastectomy incision do not have significantly greater rates of BCRL. Oncologic safety should be prioritized when considering lymph node retrieval technique.