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Understanding which breast cancer patients will develop collateralized lymphatic pathways
Shayan M. Sarrami
*, Michael Mazarei, Nicolás M. Kass, Lauriane Pinto, Carolyn De La Cruz
Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
Background:Collateralization and angiogenesis of lymphatic channels are thought to form as outflow tracts for areas of lymphatic buildup following trauma. In our previous work, we have found that radiation obliterates the lymphatics of a region. In this study, we aim to assess how cancer treatments correlate with the formation of new lymphatic pathways via collateralization and angiogenesis.
MethodsWe performed a retrospective review of breast cancer patients who received ICG lymphography of their chest from December 2014 to January 2026. We compared the formation of cross-body drainage channels in normal individuals and in in breast cancer patients. Multivariate analysis was performed to analyze the association between breast cancer treatments and the presence of cross body drainage.
ResultsOur cohort included 95 breast cancer patients (173 hemi-trunks), and a subgroup of 20 women (40 hemi-trunks) with no breast cancer history. In hemi-trunks with no breast interventions, there was no cross-body drainage appreciated, which was significantly different from the breast cancer treatment group, in which 45% (n=55) of hemi trunks had contralateral drainage (P<0.05). In total 78.6% of patients underwent mastectomy, 26.6% axillary dissection, 65.3% chemotherapy, and 42% radiation. On multivariate analysis, those who underwent radiation had a significantly increased incidence of contralateral drainage. Of note, individuals with inguinal drainage pathways were more likely to have cross body lymphatic flow (18%).
ConclusionWe show that cross body drainage is significantly less likely in patients with no prior cancer treatment. This aberrant pathway is significantly more likely to occur in pts who have undergone radiation therapy and appears to form as an outflow track for truncal lymphedema. Similarly, the inguinal drainage pathway may help aid drainage of the trunk following cancer treatment.
Models adjusted for BMI, tissue expander size, and axillary irradiation. OR > 1 indicates higher odds with early exchange.
Back to 2026 Abstracts
Models adjusted for BMI, tissue expander size, and axillary irradiation. OR > 1 indicates higher odds with early exchange.
