Addition of SLNB to mastectomy is not associated with a significant increase in measured or self-reported lymphedema rates. Patients who underwent mastectomy with SLNB or no axillary surgery reported similar lymphedema symptoms. Patients who underwent mastectomy with ALND more commonly reported symptoms associated with lymphedema compared to those with SLNB or no axillary surgery ( p < 0.0001). Mastectomy with ALND was associated with a significantly greater mean weight-adjusted arm volume change compared to mastectomy with SLNB ( p < 0.0001) and without axillary surgery ( p = 0.0028). SLNB at the time of mastectomy did not result in an increased mean weight-adjusted arm volume compared to mastectomy without axillary surgery ( p = 0.76). Multivariate analysis was used to assess clinical characteristics associated with increased weight-adjusted arm volume and patient-reported lymphedema symptoms. 88.0 % (103/117) of patients completed the LEFT-BC questionnaire evaluating symptoms associated with lymphedema. Of 234 mastectomies performed, 15.8 % (37/234) had no axillary surgery, 63.7 % (149/234) had SLNB, and 20.5 % (48/234) had axillary lymph node dissection (ALND). Perometer arm measurements were used to calculate weight-adjusted arm volume change at each follow-up. 117 patients who underwent bilateral mastectomy were prospectively screened for lymphedema. We sought to determine the risk of lymphedema after mastectomy with and without nodal evaluation. It is unknown if adding sentinel lymph node biopsy (SLNB) to prophylactic mastectomy increases the risk of lymphedema. Women diagnosed with or at high risk for breast cancer increasingly choose prophylactic mastectomy.
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