Background and Objectives: Breast cancer-related lymphedema (BCRL) is a complication of axillary lymph node dissection (ALND). Immediate lymphatic reconstruction (ILR) may help to decrease lymphedema after ALND by creating lymphatic bypasses. This retrospective single-institution study aimed to compare lymphedema in patients undergoing ALND with and without ILR. Materials and Methods: Bioimpedance and limb measurements determined the presence of BCRL. The categorical data that were collected and analyzed included BMI, comorbidities, BCRL onset, and number of lymphatic bypasses. Pearson’s chi-square test and multivariable logistic regression were performed to identify factors associated with the onset of lymphedema. An odds ratio compared the incidence of BCRL with and without ILR. Results: In total, 186 patients underwent ALND, 44 (24%) with ILR and 142 (76%) without. The mean number of bypasses during ILRs created was 3.54. The odds of developing lymphedema with ILR were 64% lower than for ALND alone. ILR patients who developed BCRL had a mean onset of 543 days post-operatively versus 389 days in the control group. Age, ethnicity, BMI, and bypass amount had no significant influence on lymphedema development. Conclusions: ILR was associated with lower rates of BCRL after ALND. Patients who developed lymphedema despite undergoing ILR did so 8 months later than the controls.

Background: Large-volume ptotic breasts are associated with incision complication rates in single-stage direct-to-implant pre-pectoral breast reconstruction. The aim is to propose an updated surgical approach for this patient population. Methods: A small retrospective case series of patients who underwent direct-to-implant breast reconstruction without a wise-pattern incision from 2019 to 2024 at a single academic institution. Results: Eight breasts from five patients fulfilled the inclusion criteria. One patient had minimal superior nipple–areolar complex ischemia with no additional postoperative complications identified. Conclusions: Refinement to a popular direct-to-implant breast reconstruction technique has the potential to decrease complication rates and improve aesthetic outcomes in large-volume ptotic breasts.