{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:47:30Z","timestamp":1792086450423,"version":"4.4.0"},"reference-count":45,"publisher":"Georg Thieme Verlag KG","funder":[{"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"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Radiation therapy following axillary lymph node dissection (ALND) is a key risk factor for lymphedema, with regional nodal irradiation (RNI) posing a higher risk. Immediate lymphatic reconstruction (ILR) with microsurgical lymphovenous anastomosis performed concurrently with ALND aims to prevent lymphedema, but its efficacy in the setting of RNI is unclear. This study compares lymphedema incidence, complications, and LYMPH-Q patient-reported outcomes (PROs) after ILR based on receipt of RNI.<\/jats:p>\n                  <jats:p>We retrospectively studied consecutive patients who underwent mastectomy and ALND with ILR between 2017 and 2024 at our institution. Patients receiving radiotherapy were categorized based on receipt of RNI, and outcomes were compared using multivariable regression, adjusting for patient and treatment factors.<\/jats:p>\n                  <jats:p>We identified 119 patients with a mean follow-up time of 25.0\u2009\u00b1\u200915.5 months, of whom 68.9% (n\u2009=\u200982) received RNI. Radiotherapy characteristics were comparable between the RNI and non-RNI cohorts, including 3D Conformal Radiotherapy use (95.1% vs. 88.2%, p\u2009=\u20090.945), mean chest wall radiation dose (5,006\u2009\u00b1\u2009238 cGy vs. 5,054\u2009\u00b1\u2009593 cGy, p\u2009=\u20090.656), and receipt of chest wall scar boosts (32.9% vs. 27.0%; p\u2009=\u20090.520). In adjusted analyses, RNI was not associated with higher odds of lymphedema (OR, 0.30; p\u2009=\u20090.429), surgical complications (OR: 1.94; p\u2009=\u20090.540), reoperation (OR: 1.11; p\u2009=\u20090.844) or worse LYMPH-Q symptoms (p\u2009=\u20090.823), function (p\u2009=\u20090.353), appearance (p\u2009=\u20090.362), or psychological well-being (p\u2009=\u20090.174) scales.<\/jats:p>\n                  <jats:p>RNI in the setting of ILR was not associated with increased surgical morbidity, lymphedema rates, or adverse patient-reported outcomes. While ILR may mitigate the expected morbidity of RNI, prospective studies are needed to establish its definitive value in this high-risk population.<\/jats:p>","DOI":"10.1055\/a-2824-6558","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T05:59:55Z","timestamp":1772603995000},"source":"Crossref","is-referenced-by-count":1,"title":["Regional Nodal Irradiation Impact on Lymphedema, Surgical Outcomes, and Quality-of-Life Following Mastectomy, Axillary Dissection, and Immediate Lymphatic Reconstruction"],"prefix":"10.1055","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":"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":"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":"Richard C.","family":"Zellars","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, 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":[[2026,3,12]]},"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":"05","key":"ref2","doi-asserted-by":"crossref","first-page":"3260","DOI":"10.1245\/s10434-025-16918-5","article-title":"Protective factors associated with normal lymphatic function after axillary lymph node dissection for breast cancer treatment","volume":"32","author":"J C Coleman-Belin","year":"2025","journal-title":"Ann Surg Oncol"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1097\/SAP.0b013e31828d7285","article-title":"Analysis of factors contributing to severity of breast cancer-related lymphedema","volume":"74","author":"M Coriddi","year":"2015","journal-title":"Ann Plast Surg"},{"issue":"07","key":"ref4","doi-asserted-by":"crossref","first-page":"1959","DOI":"10.1245\/s10434-009-0452-2","article-title":"The risk of developing arm lymphedema among breast cancer survivors: a meta-analysis of treatment factors","volume":"16","author":"R J Tsai","year":"2009","journal-title":"Ann Surg Oncol"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10549-025-07829-w","article-title":"Socioeconomic and ethnic disparities in breast cancer-related lymphedema and quality-of-life after immediate lymphatic reconstruction","volume":"215","author":"A M Hassan","year":"2025","journal-title":"Breast Cancer Res Treat"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1055\/a-2717-5063","article-title":"Impact of obesity on surgical and patient-reported outcomes following immediate lymphatic reconstruction","author":"A M Hassan","year":"2025","journal-title":"J Reconstr Microsurg"},{"issue":"33","key":"ref7","doi-asserted-by":"crossref","first-page":"3560","DOI":"10.1200\/JCO-25-01281","article-title":"Lymphedema Treatment Act: a critical step for cancer survivors, but unresolved equity gaps persist","volume":"43","author":"A M Hassan","year":"2025","journal-title":"J Clin Oncol"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s10549-016-4089-0","article-title":"Radiation therapy targets and the risk of breast cancer-related lymphedema: a systematic review and network meta-analysis","volume":"162","author":"S F Shaitelman","year":"2017","journal-title":"Breast Cancer Res Treat"},{"issue":"03","key":"ref9","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 Women's Health Study","volume":"130","author":"R L Ahmed","year":"2011","journal-title":"Breast Cancer Res Treat"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1080\/028418600750013131","article-title":"Late treatment-related morbidity in breast cancer patients randomized to postmastectomy radiotherapy and systemic treatment versus systemic treatment alone","volume":"39","author":"I H\u00f8jris","year":"2000","journal-title":"Acta Oncol"},{"issue":"02","key":"ref11","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/S0959-8049(96)00375-9","article-title":"Arm morbidity after sector resection and axillary dissection with or without postoperative radiotherapy in breast cancer stage I. Results from a randomised trial","volume":"33","author":"G Liljegren","year":"1997","journal-title":"Eur J Cancer"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"S234","DOI":"10.1097\/SAP.0000000000001864","article-title":"Lymphedema incidence after axillary lymph node dissection: quantifying the impact of radiation and the lymphatic microsurgical preventive healing approach","volume":"82","author":"A R Johnson","year":"2019","journal-title":"Ann Plast Surg"},{"issue":"03","key":"ref13","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/j.ijrobp.2013.02.018","article-title":"A model to estimate the risk of breast cancer-related lymphedema: combinations of treatment-related factors of the number of dissected axillary nodes, adjuvant chemotherapy, and radiation therapy","volume":"86","author":"M Kim","year":"2013","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"03","key":"ref14","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.ijrobp.2013.11.232","article-title":"The impact of radiation therapy on the risk of lymphedema after treatment for breast cancer: a prospective cohort study","volume":"88","author":"L E Warren","year":"2014","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"04","key":"ref15","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1056\/NEJMoa1415369","article-title":"Internal mammary and medial supraclavicular irradiation in breast cancer","volume":"373","author":"P M Poortmans","year":"2015","journal-title":"N Engl J Med"},{"issue":"04","key":"ref16","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1056\/NEJMoa1415340","article-title":"Regional nodal irradiation in early-stage breast cancer","volume":"373","author":"T J Whelan","year":"2015","journal-title":"N Engl J 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Surg"},{"issue":"01","key":"ref20","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1089\/lrb.2020.0120","article-title":"Liposuction of breast cancer-related arm lymphedema reduces fat and muscle hypertrophy","volume":"20","author":"T Karlsson","year":"2022","journal-title":"Lymphat Res Biol"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1097\/prs.0000000000012646","article-title":"Hospital setting impact on breast cancer-related lymphedema and quality-of-life after immediate lymphatic reconstruction","author":"A M Hassan","year":"2025","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref22","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1097\/SLA.0000000000005952","article-title":"Efficacy of immediate lymphatic reconstruction to decrease incidence of breast cancer-related lymphedema: preliminary results of randomized controlled trial","volume":"278","author":"M Coriddi","year":"2023","journal-title":"Ann 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Microsurg"},{"issue":"09","key":"ref26","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1055\/s-0044-1785680","article-title":"Lymphovenous bypass for immediate lymphatic reconstruction in breast cancer patients undergoing axillary lymph node dissection: minimizing the risk of upper extremity lymphedema","volume":"40","author":"M C M\u00e9dor","year":"2024","journal-title":"J Reconstr Microsurg"},{"issue":"11","key":"ref27","doi-asserted-by":"crossref","first-page":"7349","DOI":"10.1245\/s10434-024-15715-w","article-title":"Lymphedema rates following axillary lymph node dissection with and without immediate lymphatic reconstruction: a prospective trial","volume":"31","author":"J W Jakub","year":"2024","journal-title":"Ann Surg Oncol"},{"issue":"03","key":"ref28","doi-asserted-by":"crossref","first-page":"373e","DOI":"10.1097\/PRS.0000000000007636","article-title":"Evaluating the impact of immediate lymphatic reconstruction for the surgical prevention of lymphedema","volume":"147","author":"A R Johnson","year":"2021","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref29","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1002\/jso.25513","article-title":"Axillary reverse mapping and lymphaticovenous bypass: lymphedema prevention through enhanced lymphatic visualization and restoration of flow","volume":"120","author":"G S Schwarz","year":"2019","journal-title":"J Surg Oncol"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1055\/s-0044-1787727","article-title":"Evaluating operative times for intraoperative conversion of axillary node biopsy to axillary lymph node dissection with immediate lymphatic reconstruction","author":"S Ahmed","year":"2024","journal-title":"J Reconstr Microsurg"},{"issue":"03","key":"ref31","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":"ref32","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":"ref33","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":"ref34","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 MHJ Hassan","year":"2025","journal-title":"Ann Surg Oncol"},{"issue":"13","key":"ref35","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":"ref36","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 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Oncol"},{"issue":"02","key":"ref40","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.ijrobp.2023.04.027","article-title":"A prospective study of radiation therapy after immediate lymphatic reconstruction: analysis of the dosimetric implications","volume":"117","author":"D Y Spiegel","year":"2023","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"06","key":"ref41","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1002\/micr.22254","article-title":"Lymphatic microsurgical preventing healing approach (LYMPHA) for primary surgical prevention of breast cancer-related lymphedema: over 4 years follow-up","volume":"34","author":"F Boccardo","year":"2014","journal-title":"Microsurgery"},{"issue":"09","key":"ref42","doi-asserted-by":"crossref","first-page":"5711","DOI":"10.1245\/s10434-023-13470-y","article-title":"Long-term surgical and patient-reported outcomes comparing skin-preserving, staged versus delayed microvascular breast reconstruction","volume":"30","author":"A M Hassan","year":"2023","journal-title":"Ann Surg Oncol"},{"issue":"01","key":"ref43","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1097\/PRS.0000000000010489","article-title":"Subpectoral implant placement is not protective against postmastectomy radiotherapy-related complications compared to prepectoral placement","volume":"153","author":"A M Hassan","year":"2024","journal-title":"Plast Reconstr Surg"},{"issue":"09","key":"ref44","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/S1470-2045(03)01191-4","article-title":"Effects of radiation on normal tissue: consequences and mechanisms","volume":"4","author":"H B Stone","year":"2003","journal-title":"Lancet Oncol"},{"issue":"09","key":"ref45","doi-asserted-by":"crossref","first-page":"6644","DOI":"10.1245\/s10434-025-17344-3","article-title":"ASO author reflections: navigating the nuances of lymphedema prevention with immediate lymphatic 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