{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T10:50:27Z","timestamp":1789123827238,"version":"build-2803163510"},"reference-count":25,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPHS"],"abstract":"<jats:p>Background: Immediate lymphatic reconstruction (ILR) has emerged as an effective intervention to reduce breast cancer-related lymphedema, which affects 2\u201330% of patients who undergo axillary lymph node dissection (ALND). Our previous research validated ILR\u2019s effectiveness over 14 months, but the duration was short and warranted further study. This study provides long-term evidence of its benefits in a well-defined patient cohort.\nMethod: This retrospective cohort study included unilateral breast cancer patients who underwent ALND between November 2019 and February 2021 with \u2265 24 months of follow-up. Patients were grouped\u00a0by whether ILR was attempted intraoperatively. Exclusion criteria were recurrence, prophylactic mastectomy, and pre-existing lymphedema. The primary outcome was lymphedema incidence at \u2265 24 months; the secondary was lymphedema-free survival. Outcomes were evaluated using Cox regression models.\nResults: Among 73 patients, we analyzed ALND patients divided into a control group (n = 57, defined as no-try or failure) and an ILR group (n = 16). The pooled median follow-up was 37 months.\u00a0(range,\u00a026~47\u00a0months). Among the ILR group, 13 underwent end-to-end anastomosis and 3 end-to-side. Postoperative lymphedema was higher in the control group (24.6%) compared to the ILR group\u00a0(6.3%). Multivariate\u00a0Cox\u00a0regression analysis showed a significantly lower hazard ratio for the ILR group (HR: 0.117, 95% CI: 0.014\u20130.965), emphasizing ILR\u2019s effectiveness in reducing lymphedema risk post-ALND. Additionally, survival plots illustrating lymphedema-free survival showed a significant difference.\nConclusion: Our study emphasizes ILR\u2019s efficacy over extended follow-up. The ILR group exhibited a lower rate of postoperative lymphedema, supporting ILR as an effective preventive measure against Breast Cancer-Related Lymphedema (BCRL) following ALND.<\/jats:p>","DOI":"10.2340\/jphs.v60.43738","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T05:10:13Z","timestamp":1750828213000},"page":"138-143","source":"Crossref","is-referenced-by-count":3,"title":["The efficacy of immediate lymphatic reconstruction in preventing breast cancer-related lymphedema: long-term follow-up study"],"prefix":"10.2340","volume":"60","author":[{"given":"Ki-Jae","family":"Kim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sun-Hyeok","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung-Pil","family":"Jung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eul-Sik","family":"Yoon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae-Ho","family":"Chung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2025,6,25]]},"reference":[{"key":"115957","doi-asserted-by":"crossref","unstructured":"Boccardo F, Campisi C, De Cian F, et al. Lymphedema microsurgical preventive healing approach: a new technique for primary prevention of arm lymphedema after mastectomy. Ann Surg Oncol. 2009; 16: 703\u2013708. https:\/\/doi.org\/10.1245\/s10434-008-0270-y","DOI":"10.1245\/s10434-008-0270-y"},{"key":"115958","doi-asserted-by":"crossref","unstructured":"Boccardo F, Campisi C, Friedman D, et al. Surgical prevention of arm lymphedema after breast cancer treatment. Ann Surg Oncol. 2011; 18: 2500\u20132505. https:\/\/doi.org\/10.1245\/s10434-011-1624-4","DOI":"10.1245\/s10434-011-1624-4"},{"key":"115959","doi-asserted-by":"crossref","unstructured":"Boccardo F, Campsisi C, De Cian F, et al. Lymphatic microsurgical preventing healing approach (LYMPHA) for primary surgical prevention of breast cancer-related lymphedema: over 4 years follow-up. Microsurgery. 2014; 34: 421\u2013424. https:\/\/doi.org\/10.1002\/micr.22254","DOI":"10.1002\/micr.22254"},{"key":"115960","doi-asserted-by":"crossref","unstructured":"Temple-Oberle C, Fraser WK, Platt A, et al. Immediate lymphatic reconstruction during axillary node dissection for breast cancer: a systematic review and meta-analysis. Plast Reconstr Surg Glob Open. 2022; 10: e4291. https:\/\/doi.org\/10.1097\/GOX.0000000000004291","DOI":"10.1097\/GOX.0000000000004291"},{"key":"115961","doi-asserted-by":"crossref","unstructured":"Levy AS, Murphy AI, Ishtihar S, et al. Lymphatic microsurgical preventive healing approach for the primary prevention of lymphedema: a 4-year follow-up. Plast Reconstr Surg. 2023; 151(2): 413\u2013420. https:\/\/doi.org\/10.1097\/PRS.0000000000009857","DOI":"10.1097\/PRS.0000000000009857"},{"key":"115962","doi-asserted-by":"crossref","unstructured":"Melisa D, Singhal D, Shillue K, et al. A 4-year institutional experience of immediate lymphatic reconstruction. Plast Reconstr Surg. 2023; 152(5): 773\u2013778. https:\/\/doi.org\/10.1097\/PRS.0000000000010381","DOI":"10.1097\/PRS.0000000000010381"},{"key":"115963","doi-asserted-by":"crossref","unstructured":"Chung JH, Kwon S-H, Jung S-P, et al. Assessing the preventive effect of immediate lymphatic reconstruction on the upper extremity lymphedema. Gland Surg. 2023; 12(3): 334\u2013343. https:\/\/doi.org\/10.21037\/gs-22-554","DOI":"10.21037\/gs-22-554"},{"key":"115964","doi-asserted-by":"crossref","unstructured":"Disipio T, Rye S, Newman B, et al. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2013; 14(6): 500\u2013501. https:\/\/doi.org\/10.1016\/S1470-2045(13)70076-7","DOI":"10.1016\/S1470-2045(13)70076-7"},{"key":"115965","doi-asserted-by":"crossref","unstructured":"McLaughlin SA, Wright MJ, Morris KT, et al. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol. 2008; 26(32): 5213\u20139. https:\/\/doi.org\/10.1200\/JCO.2008.16.3725","DOI":"10.1200\/JCO.2008.16.3725"},{"key":"115966","doi-asserted-by":"crossref","unstructured":"Thompson M, Korourian S, Henry-Tilman R, et al. Axillary reverse mapping (ARM): a new concept to identify and enhance lymphatic preservation. Ann Sug Oncol. 2007; 14(6): 1890\u20135. https:\/\/doi.org\/10.1245\/s10434-007-9412-x","DOI":"10.1245\/s10434-007-9412-x"},{"key":"115967","doi-asserted-by":"crossref","unstructured":"Johnson AR, Fleishman A, Granoff SD, et al. Evaluating the impact of immediate lymphatic reconstruction for the surgical prevention of lymphedema. Plast Reconstr Surg. 2021; 147(3): 373\u2013381. https:\/\/doi.org\/10.1097\/PRS.0000000000007636","DOI":"10.1097\/PRS.0000000000007636"},{"key":"115968","doi-asserted-by":"crossref","unstructured":"Pressman PI. Surgical treatment and lymphedema. Cancer. 1998; 83(12 Suppl American): 2782\u20132787. https:\/\/doi.org\/10.1002\/(SICI)1097-0142(19981215)83:12B+%3C2782::AID-CNCR26%3E3.0.CO;2-2","DOI":"10.1002\/(SICI)1097-0142(19981215)83:12B+<2782::AID-CNCR26>3.0.CO;2-2"},{"key":"115969","doi-asserted-by":"crossref","unstructured":"Levy AS, Rhode CH, et al. Lymphatic microsurgical preventive healing approach for primary prevention of lymphedema : a 4-year follow up. Plast Reconstr Surg. 2023; 151(2): 413\u2013420. https:\/\/doi.org\/10.1097\/PRS.0000000000009857","DOI":"10.1097\/PRS.0000000000009857"},{"key":"115970","doi-asserted-by":"crossref","unstructured":"Weinstein B, Le NK, Robertson E, et al. Reverse lymphatic mapping and immediate microsurgical lymphatic reconstruction reduced early risk of breast cancer-related lymphedema. Plast Reconstr Surg. 2022; 149(5): 1061\u20131069. https:\/\/doi.org\/10.1097\/PRS.0000000000008986","DOI":"10.1097\/PRS.0000000000008986"},{"key":"115971","doi-asserted-by":"crossref","unstructured":"Magnus J, Saeg F, Meade A, et al. Immediate lymphatic reconstruction for prevention of secondary lymphedema: a meta-analysis. J Plast Reconstr Aesthet Surg. 2022; 75(3): 1130\u20131141. https:\/\/doi.org\/10.1016\/j.bjps.2021.11.094","DOI":"10.1016\/j.bjps.2021.11.094"},{"key":"115972","doi-asserted-by":"crossref","unstructured":"Feldman S, Bansil H, Ascherman J, et al. Single institution experience with lymphatic microsurgical preventive healing approach (LYMPHA) for the primary prevention of lymphedema. 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Comparison of quality of life, satisfaction with surgery and shoulder-arm morbidity in breast cancer survivors submitted to breast-conserving therpay or mastectomy followed by immediate breast reconstruction. Clinical Science. 2010; 65(8): 781\u2013787. https:\/\/doi.org\/10.1590\/S1807-59322010000800009","DOI":"10.1590\/S1807-59322010000800009"},{"key":"115976","doi-asserted-by":"crossref","unstructured":"Pafitanis G, Narushima M, Yamamoto T, et al. Insights to establish early learning curve in clinical supermicrosurgery. Microsurgery. 2019; 39(1): 100\u2013101. https:\/\/doi.org\/10.1002\/micr.30401","DOI":"10.1002\/micr.30401"},{"key":"115977","doi-asserted-by":"crossref","unstructured":"Ishiura R, Yamamoto T, Saito T, et al. Comparison of lymphovenous shunt methods in a rat model: supermicrosurgical lymphaticovenular anastomosis versus microsurgical lymphaticovenous implantation. 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