{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T23:03:43Z","timestamp":1789513423106,"version":"build-2803163510"},"reference-count":43,"publisher":"Georg Thieme Verlag KG","issue":"08","funder":[{"name":"IUSM Inclusive Excellence Resident Scholar Program"},{"DOI":"10.13039\/100030719","name":"National Institute of Health Sciences","doi-asserted-by":"crossref","award":["K08HL167164"],"award-info":[{"award-number":["K08HL167164"]}],"id":[{"id":"10.13039\/100030719","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>While obesity is a known risk factor for developing breast cancer\u2013related lymphedema (BCRL) after axillary lymph node dissection (ALND), its impact on outcomes of immediate lymphatic reconstruction (ILR) is yet to be elucidated. The purpose of this study is to assess the influence of obesity on BCRL incidence and patient-reported outcomes following ILR.<\/jats:p>\n                  <jats:p>We retrospectively studied consecutive patients who underwent ILR following ALND between 2017 and 2024 across a university hospital system. BCRL prevalence and condition-specific (LYMPH-Q) quality-of-life performance were compared and correlated via multivariable regression.<\/jats:p>\n                  <jats:p>We identified 172 patients (mean body mass index [BMI]: 29.5\u2009\u00b1\u20096.9\u2009kg\/m2) with 72 patients (41.9%) categorized as obese (BMI \u2265 30). BCRL incidence was 7.0% with no significant difference between groups (obese, 8.3% vs. nonobese, 6.0%; p\u2009=\u20090.553). In adjusted models, obesity was not associated with higher risk of BCRL (OR, 0.90; 95% CI, 0.23\u20133.47; p\u2009=\u20090.875), surgical complications (OR, 1.18; 95% CI, 0.50\u20132.74, p\u2009=\u20090.708) or unplanned reoperation (OR, 0.72; 95% CI, 0.29\u20131.80, p\u2009=\u20090.479). However, obese patients showed significantly lower mean scores in the LYMPH-Q symptom scale (66.7\u2009\u00b1\u200927.7 vs. 84.7\u2009\u00b1\u200916.8, p\u2009=\u20090.004) when compared with nonobese patients. In adjusted models, obesity was associated with independently lower LYMPH-Q symptom scores (\u221213.8; 95% CI, \u221226.7 to \u22120.81; p\u2009=\u20090.038).<\/jats:p>\n                  <jats:p>ILR mitigated the risk of BCRL associated with obesity following ALND. However, obesity remained associated with significantly worse patient-reported lymphedema symptom burden following ILR. These findings highlight a dissociation between objective risk reduction and subjective symptom burden, underscoring the need for integrated assessment and targeted symptom management protocols.<\/jats:p>","DOI":"10.1055\/a-2717-5063","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T22:51:04Z","timestamp":1760050264000},"page":"711-718","source":"Crossref","is-referenced-by-count":1,"title":["Impact of Obesity on Surgical and Patient-Reported Outcomes Following Immediate Lymphatic Reconstruction"],"prefix":"10.1055","volume":"42","author":[{"given":"Abbas M.","family":"Hassan","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John P.","family":"Hajj","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John P.","family":"Lewis","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla S.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Division of Breast Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Folasade O.","family":"Imeokparia","sequence":"additional","affiliation":[{"name":"Division of Breast Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kandice K.","family":"Ludwig","sequence":"additional","affiliation":[{"name":"Division of Breast Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel M.","family":"Danforth","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Jason","family":"VonDerHaar","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravinder","family":"Bamba","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary E.","family":"Lester","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aladdin H.","family":"Hassanein","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,10,27]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/S1470-2045(13)70076-7","article-title":"Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis","volume":"14","author":"T DiSipio","year":"2013","journal-title":"Lancet Oncol"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1097\/PRS.0000000000007021","article-title":"Body mass index and lymphedema morbidity: comparison of obese versus normal-weight patients","volume":"146","author":"A K Greene","year":"2020","journal-title":"Plast Reconstr Surg"},{"issue":"07","key":"ref3","doi-asserted-by":"crossref","first-page":"818","DOI":"10.3390\/biomedicines9070818","article-title":"The effects of obesity on lymphatic pain and swelling in breast cancer patients","volume":"9","author":"M R Fu","year":"2021","journal-title":"Biomedicines"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"S363","DOI":"10.1097\/SAP.0000000000003457","article-title":"Efficacy of immediate lymphatic reconstruction in prevention of breast cancer-related lymphedema","volume":"90","author":"N K Le","year":"2023","journal-title":"Ann Plast Surg"},{"issue":"08","key":"ref5","doi-asserted-by":"crossref","first-page":"172","DOI":"10.21037\/atm.2019.03.44","article-title":"Obese patients have higher risk of breast cancer-related lymphedema than overweight patients after breast cancer: a meta-analysis","volume":"7","author":"R Wu","year":"2019","journal-title":"Ann Transl Med"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s10549-013-2715-7","article-title":"Impact of body mass index and weight fluctuation on lymphedema risk in patients treated for breast cancer","volume":"142","author":"L S Jammallo","year":"2013","journal-title":"Breast Cancer Res Treat"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1111\/j.1524-4741.2009.00855.x","article-title":"Obesity is a risk factor for developing postoperative lymphedema in breast cancer patients","volume":"16","author":"L K Helyer","year":"2010","journal-title":"Breast J"},{"issue":"06","key":"ref9","first-page":"853","article-title":"Body mass index and breast cancer treatment-related lymphedema","volume":"19","author":"S H Ridner","year":"2011","journal-title":"Support Care Cancer"},{"issue":"05","key":"ref10","first-page":"278","article-title":"Body mass index increases the risk of breast cancer-related lymphedema at 6-18 months after surgery: a retrospective study","volume":"31","author":"L Wang","year":"2023","journal-title":"Support Care Cancer"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1007\/s10549-011-1667-z","article-title":"Risk factors for lymphedema in breast cancer survivors, the Iowa 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Ahmed","year":"2024","journal-title":"J Reconstr Microsurg"},{"issue":"03","key":"ref27","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1245\/s10434-020-09104-2","article-title":"Immediate lymphatic reconstruction after axillary lymphadenectomy: a single-institution early experience","volume":"28","author":"J A Cook","year":"2021","journal-title":"Ann Surg Oncol"},{"issue":"12","key":"ref28","doi-asserted-by":"crossref","first-page":"4695","DOI":"10.1245\/s10434-020-08890-z","article-title":"Lymphedema prevention surgery: improved operating efficiency over time","volume":"27","author":"K Shaffer","year":"2020","journal-title":"Ann Surg Oncol"},{"issue":"07","key":"ref29","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1089\/wound.2021.0056","article-title":"Immediate lymphatic reconstruction to prevent breast cancer-related lymphedema: a systematic review","volume":"11","author":"J A Cook","year":"2022","journal-title":"Adv Wound Care (New Rochelle)"},{"issue":"08","key":"ref30","doi-asserted-by":"crossref","first-page":"5817","DOI":"10.1245\/s10434-025-17301-0","article-title":"Long-term outcomes of lymphedema after immediate lymphatic reconstruction following axillary lymph node dissection","volume":"32","author":"A M Hassan","year":"2025","journal-title":"Ann Surg Oncol"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"S437","DOI":"10.1097\/SAP.0000000000003956","article-title":"The impact of obesity on success of immediate lymphatic reconstruction for prevention of breast cancer-related lymphedema","volume":"92","author":"D J Wainwright","year":"2024","journal-title":"Ann Plast Surg"},{"issue":"13","key":"ref32","doi-asserted-by":"crossref","first-page":"8665","DOI":"10.1245\/s10434-021-10290-w","article-title":"Longitudinal, long-term comparison of single- versus multipoint upper limb circumference periodical measurements as a tool to predict persistent lymphedema in women treated surgically for breast cancer: an optimized strategy to early diagnose lymphedema and avoid permanent sequelae in breast cancer survivors","volume":"28","author":"C Furlan","year":"2021","journal-title":"Ann Surg Oncol"},{"issue":"02","key":"ref33","doi-asserted-by":"crossref","first-page":"e3431","DOI":"10.1097\/GOX.0000000000003431","article-title":"Immediate lymphatic reconstruction: technical points and literature review","volume":"9","author":"M Coriddi","year":"2021","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"08","key":"ref34","doi-asserted-by":"crossref","first-page":"2831","DOI":"10.1016\/j.bjps.2022.06.076","article-title":"Utilizing a lower extremity vein graft for immediate lymphatic reconstruction","volume":"75","author":"R Friedman","year":"2022","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"13","key":"ref35","doi-asserted-by":"crossref","first-page":"8514","DOI":"10.1245\/s10434-024-16047-5","article-title":"Effect of immediate lymphatic reconstruction on 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outcomes of prepectoral vs subpectoral implant-based breast reconstruction","volume":"43","author":"M Asaad","year":"2023","journal-title":"Aesthet Surg J"},{"key":"ref39","doi-asserted-by":"crossref","first-page":"S453","DOI":"10.1097\/SAP.0000000000003950","article-title":"A multi-institutional analysis of a textbook outcome among patients undergoing microvascular breast reconstruction","volume":"92","author":"R L Shammas","year":"2024","journal-title":"Ann Plast Surg"},{"issue":"04","key":"ref40","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1016\/j.jamcollsurg.2013.03.031","article-title":"Impact of obesity on outcomes in breast reconstruction: analysis of 15,937 patients from the ACS-NSQIP datasets","volume":"217","author":"J P Fischer","year":"2013","journal-title":"J Am Coll Surg"},{"issue":"05","key":"ref41","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1016\/j.breast.2013.05.009","article-title":"The differential effect of BMI on prosthetic versus 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Surg"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2717-5063.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T22:35:45Z","timestamp":1789511745000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2717-5063"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,9]]},"references-count":43,"journal-issue":{"issue":"08","published-online":{"date-parts":[[2026,9,15]]},"published-print":{"date-parts":[[2026,10]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2717-5063","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,10,9]]},"published":{"date-parts":[[2025,10,9]]}}}