A Single Institution Experience With Immediate Lymphatic Reconstruction: Impact of Insurance Coverage on Risk Reduction

Background and objectives: Immediate lymphatic reconstruction (ILR) performed to prevent breast cancer related lymphedema is not consistently covered by insurance payors in the United States.

Methods: Retrospective review was performed on a prospective database of ILR candidates from 2018 to 2022. Candidates were identified as patients with clinical axillary lymph node involvement at the time of breast cancer diagnosis. Patient demographics, insurance type, and development of lymphedema were recorded.

Results: One hundred and eighty ILR candidates were identified, 50 of whom underwent ILR. Non-ILR patients were more likely to be of black race, have Medicaid health insurance, earn lower median household income, and have lower rates of out-of-pocket payment when not covered by insurance. In 40 cases where ILR was indicated but not performed, 55% were due to financial reasons. After a minimum of 1 year follow up, 14.6% (6/41) of patients who underwent ILR had lymphedema, compared with 12.5% (9/72) of patients who had no clinical indication for ILR and 40% (10/25) of patients who did not undergo ILR when clinically indicated (p = 0.012).

Conclusions: Disparities in insurance coverage and financial resources may adversely impact access and outcomes in patients clinically indicated for ILR.