Different patterns of breast cancer-related lymphedema according to body mass index

Abstract Purpose This study aimed to clarify how body mass index (BMI) affects the development of breast cancer-related lymphedema (BCRL) and to improve the postoperative follow-up for BCRL. Methods In this prospective study, patients with operable breast cancer were registered in a single institute between November 2009 and July 2010. The incidence rates of lymphedema at 1, 3, and 5 years after surgery were assessed according to BMI, and the trend of newly developed BCRL was examined. The cut-off point of BMI was 25 kg/m2 according to the definition of obesity by the Japan Society for the Study of Obesity. Results A total of 379 patients were analyzed in this study. The multivariate analysis of the whole population showed that high BMI, axillary dissection, and radiotherapy remained as risk factors for BCRL. Patients with high BMI showed a significantly higher incidence of lymphedema than those with low BMI at 1 year (p < 0.0001), regardless of axillary procedures (39.1% vs. 16.3% for axillary dissection, 15.6% vs. 1.5% for sentinel lymph node biopsy), but not at 3 and 5 years. Once BCRL was developed, patients with high BMI showed slow recovery, and 50.0% of the patients retained their lymphedema at 5 years. However, patients with low BMI showed rapid recovery, and 26.7% retained their lymphedema at 3 years (p = 0.04). Conclusion Preoperative BMI affected BCRL, regardless of axillary surgery or radiotherapy. Patients with high BMI should be provided appropriate information about BCRL before surgery and careful checkups after surgery.