Cell-in-cell (CIC) structures, characterized by one cell engulfing another, play a paradoxical role in cancer metastasis. This review synthesizes their dual nature: while CIC can suppress metastasis by eliminating aberrant cells or activating immune responses, it also drives tumor progression through clonal evolution, metabolic adaptation, and genomic instability. The clinical relevance of CIC varies across cancer types, correlating with both favorable and poor prognoses depending on disease stage and microenvironmental context. Emerging therapeutic strategies aim to harness protective CIC mechanisms or inhibit pro-metastatic pathways, though challenges such as biomarker validation and dynamic tracking persist. Future research integrating advanced technologies will elucidate the spatiotemporal complexity of CIC, enabling tailored interventions to disrupt metastatic cascades. By bridging fundamental biology and clinical translation, CIC represents a promising yet intricate frontier in the battle against metastatic cancer.

BACKGROUND:Flap pedicle thrombosis is a frequent cause of flap compromise, which is a major complication following free flap breast reconstruction. This study aims to investigate the relationship between preoperative coagulation parameters and the risk of postoperative flap pedicle thrombosis, providing guidance for preoperative assessment and perioperative management. METHODS:A retrospective analysis was conducted on all patients who underwent free flap breast reconstruction at our institution between January 2021 and August 2025. Patient demographics, surgical details, preoperative coagulation test results (including prothrombin time, activated partial thromboplastin time, fibrinogen, thrombin time, and D-dimer) and outcomes were recorded. Patients were categorized according to their preoperative coagulation test results. Demographics, surgical information, and incidence of flap pedicle thrombosis were compared between groups. Furthermore, patients were divided according to the occurrence of flap pedicle thrombosis. Preoperative coagulation parameters were compared between the two groups, and a multivariate logistic regression was performed to identify potential risk factors. RESULTS:A total of 154 patients (160 breasts) were included. Fifty-two breasts (32.5%) were categorized to the asymptomatic hypercoagulable group, and 108 breasts (67.5%) to the non-hypercoagulable group. Postoperative flap pedicle thrombosis occurred in nine breasts (5.6%), including two arterial thromboses and seven venous thromboses. No significant difference in postoperative flap pedicle thrombosis was observed between the two groups (9.6% vs. 3.7%, p = 0.152). Multivariate logistic regression indicated that immediate flap breast reconstruction might be an independent risk factor (p = 0.028). CONCLUSION:This study suggested no significant association between preoperative coagulation parameters (including PT, APTT, FIB, TT, and D-dimer) and flap pedicle thrombosis following free flap breast reconstruction.

BACKGROUND:Determining the need for a bipedicled deep inferior epigastric perforator (DIEP) flap is a critical challenge in delayed breast reconstruction. The traditional, experience-based approach is often subjective and inaccurate. We aimed to evaluate a novel quantitative strategy to optimize this decision-making process. METHODS:Patients undergoing delayed DIEP flap reconstruction managed with a new strategy were prospectively enrolled from January 2022 to December 2024, a historical conventional cohort served as the control. The quantitative strategy combines preoperative three-dimensional measurement to define the breast volume deficit with intraoperative indocyanine green angiography to assess real-time flap perfusion. Primary endpoints were the final volume restoration ratio (VRR), rate of bipedicled flap use, and flap-related complications. Follow-up was a minimum of six months. Multivariable logistic regression was performed to control for confounders and identify independent predictors of optimal volumetric symmetry (VRR 90-110%). RESULTS:A total of 183 patients were included (Strategy: n = 82; Conventional: n = 101). The Strategy group demonstrated a significantly higher rate of bipedicled flaps (58.5% vs. 40.6%, p = 0.016) and optimal symmetry (45.1% vs. 25.7%, p = 0.010). Multivariable analysis confirmed the quantitative strategy as a significant independent predictor for achieving optimal symmetry (odds ratio 2.53; p = 0.005), after adjusting for demographics and defect size. The incidence of flap-related complications was significantly lower in the Strategy group (2.4% vs. 10.9%, p = 0.040). CONCLUSION:This strategy provides objective guidance for selecting single-pedicle versus bipedicled DIEP flaps in delayed breast reconstruction and is associated with significantly improved postoperative symmetry while reducing flap-related complications.

The dynamic behavior of unoperated native breasts during pectoralis major contraction remains poorly defined. This study aimed to quantitatively assess native breast displacement during pectoralis major contraction using three-dimensional (3D) imaging. Healthy, unoperated adult women underwent 3D surface scanning at rest and during maximal pectoralis major contraction. Six anatomical landmarks were identified per breast: nipple midpoint (Nm), inframammary fold midpoint (IMFm), and midpoints of the superior, inferior, medial, and lateral boundaries. For each point, spatial coordinates (X, Y, Z) and distance from the sternal notch (D) were extracted. Repeated-measures ANOVA compared displacement among landmarks. Sagittal contour profiles were graded: A, complete overlap; B, localized displacement without crossover; C, crossover displacement; D, distorting displacement. Visual assessment of breast motion was performed independently. Thirty-eight women (76 breasts) were included. All landmarks showed superior displacement, largest at IMFm (ΔY = 2.689 ± 2.331 mm). Displacement differed significantly among landmarks (F = 4.326, P = 0.004, partial η2 = 0.105). Sagittal contour analysis classified 42.1 http://www.springer.com/00266 .

BACKGROUND:There remain ongoing concerns regarding the accessibility of breast reconstruction. We aimed to analyze recent data from the Surveillance, Epidemiology, and End Results (SEER) database to reveal trends in immediate and early delayed breast reconstruction across the United States. METHODS:Patients undergoing mastectomy from 2010 to 2020 were identified using the SEER database. The trends of postmastectomy reconstruction were described. Multivariate logistic regressions were performed to identify covariates associated with reconstruction. Multiple comparisons based on logistic models were employed to assess interactions among reconstruction-related factors. RESULTS:A total of 84,088 patients underwent reconstruction within four months following mastectomy, accounting for 36.4% of all postmastectomy patients. Immediate and early delayed reconstruction use increased from 26.4% in 2010 to 41.8% in 2020, with increased proportion of implant-based techniques over time. The receipt of reconstruction among younger patients not only demonstrated a higher proportion, but also exhibited a more significant upward trend over the years (P for interaction < 0.001). The correlation between substantial partner support and willingness for reconstruction was stronger among older patients (P for interaction < 0.001). While patients exhibiting favorable responses to neoadjuvant therapy typically displayed heightened propensities for reconstruction, this disparity was particularly pronounced among older individuals (P for interaction < 0.001). CONCLUSION:Breast reconstruction has increased over time, with implant-based reconstruction being the most common approach employed. The decision-making process for reconstruction is influenced by various factors, with noteworthy interactions among them. Collaboration among patients, tumor surgeons, and reconstructive surgeons is essential for reconstruction decisions. LEVEL OF EVIDENCE III:This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Xenogeneic decellularized adipose matrix(DAM) scaffolds are significant in soft tissue regeneration by addressing donor site morbidity and limited donor availability. However, natural DAM xenotransplantation remains unachieved. Previous efforts have relied on chemical modifications to reduce foreign body reactions, with inherent drawbacks and limited outcomes. This xenotransplantation study proposes a natural DAM hydrogel scaffold that achieves efficient and functional xenotransplant fat regeneration. Primarily, hydrophilic DAM(H-DAM) is confirmed to have lower antigen content, but its regenerative potential is constrained by encapsulation that impedes seed cell infiltration. Thus, H-DAM hydrogel is prepared to enhance the speed and extent of cell infiltration. It is observed that the topological structure impacts cell infiltration, immune inflammatory response, and regenerative outcomes. Low-crosslinked hydrogels emerged as optimal for adipogenic differentiation due to loose networks and natural degradation rates synchronizing with cell infiltration. Furthermore, the wall-like rather than filamentous structure provides a superior niche for stem cell engraftment and activity. Finally, integrated multi-omics data analysis demonstrated that the regenerated fat tissue functionally mimics native fat tissue. These findings indicate that xenogeneic H-DAM gel scaffolds support both structural and functional reconstruction of adipose tissue, offering novel insights and a promising approach for clinical translation in DAM-based therapies.

BACKGROUND:Secondary lymphedema, a common complication following lymph node dissection, affecting up to 53% of cancer survivors, imposes significant morbidity and reduced quality of life. Immediate lymphatic reconstruction (ILR) has emerged as a preventive strategy; however, its efficacy remains unclear. METHODS:We conducted a PRISMA/AMSTAR-compliant systematic review and meta-analysis. A comprehensive search of PubMed, EMBASE, and Web of Science (2009-2024) identified studies evaluating ILR for lymphedema prevention. Random-effects models were used to calculate pooled odds ratios (ORs) for comparative studies and pooled incidence proportions for single-arm studies, each with 95% confidence intervals (CIs). Subgroup analyses examined extremity site, follow-up duration, BMI, and study design. Publication bias was assessed with funnel plots and Egger's test. RESULTS:We included 42 studies with a total of 4539 patients. Among comparative studies, ILR was associated with roughly a 75% reduction in lymphedema risk (pooled OR = 0.25, 95% CI 0.17-0.36, p=0.004). A temporal decline in ILR's protective effect was observed: OR 0.11 at <1 year follow-up versus OR 0.41 at ≥2 years (p=0.003). Across 19 single-arm studies, the pooled lymphedema incidence after ILR was 7.34% (95% CI 4.97-10.71%), rising to ∼20% in studies with >2 years of follow-up. Heterogeneity among studies was moderate (I² = 51%). Funnel plots indicated potential publication bias in comparative studies (Egger's test: z=-2.14, p=0.032), but not in single-arm studies (p=0.105). CONCLUSION:ILR reduces the risk of cancer-related secondary lymphedema, particularly for breast cancer patients in the early postoperative period. Standardized surgical protocols and prolonged follow-up are needed to optimize and confirm long-term benefits.

BACKGROUND:Oil cyst formation is a common complication following autologous fat grafting (AFG) for breast augmentation. Despite various fat processing techniques, no consensus exists on the optimal method to mitigate this complication. The authors introduce an innovative fat processing approach, the ultrafiltration adsorption technique, designed to prevent postoperative breast oil cysts in large-volume AFG for breast augmentation. This study aimed to evaluate the clinical efficacy of this technique. METHODS:A retrospective study was conducted on 116 patients who underwent primary aesthetic AFG breast augmentation with the final purified fat tissue. Demographic data, operative details, and postoperative outcomes were analyzed. RESULTS:The mean patient age was 34 ± 4 years, and the mean body mass index was 20.19 ± 1.39 kg/m 2 . The average fat volume injected per breast was 210.00 mL ± 39.00 mL. During the 3 to 12 months of follow-up, no palpable nodules were observed in any patients, and ultrasound imaging confirmed that there were no cysts in aesthetic patients. Among 20 aesthetic patients (40 breasts), the average postoperative breast volume retention rate was 67.28%. CONCLUSIONS:The ultrafiltration adsorption technique is an effective fat processing method. It significantly reduces the formation of oil cysts and improves volume retention rates in large-volume AFG breast augmentation.

Breast cancer (BC) is a prevalent malignancy in women, often necessitating tumor resection and breast reconstruction surgeries. However, the post-operation scars can be of concern, as hypertrophic scars (HS) can profoundly impact patients' quality of life. Our study used the bidirectional Mendelian randomization (MR) method to explore the potential relationship between BC and HS. We conducted a comprehensive genetic analysis using a large meta-analysis dataset comprising the BCAC, FinnGen, MRC-IEU, and GTEx eQTL datasets. We identified independent genetic loci associated with BC and HS among individuals of European ancestry. These loci served as instrumental variables (SNPs) in MR analysis. We used the inverse-variance weighted and weighted median methods, with the odds ratio (OR) as the effect measure, to investigate the causal relationship between breast disease and HS, and all significance was corrected by FDR and Bonferroni. We assessed heterogeneity and horizontal pleiotropy through Cochran's Q, MR-PRESSO, and MR-Egger intercept tests. Moreover, a leave-one-out sensitivity analysis was performed to evaluate the impact of individual SNPs on the MR study. The MR analysis showed a significant positive association between BC and HS (OR = 1.31, 95

BACKGROUND:The deep inferior epigastric perforator (DIEP) flap technique has gained popularity due to its muscle-sparing properties, significantly reducing morbidity and enhancing aesthetic outcomes in breast reconstruction. In a considerable number of patients, dominant perforators traverse tendinous intersections (TI) of the rectus abdominis muscle, referred to as intra-TI perforators (ITIP). Our study pursued two principal objectives: to determine the accuracy of preoperative computed tomography angiography (CTA) in identifying ITIP and to evaluate whether utilizing ITIP in DIEP flap harvest impacts flap perfusion or elevates the incidence of donor-site complications. METHODS:We conducted a retrospective analysis of 81 DIEP flaps from 54 female patients between 2022 and 2024. Patients were categorized into ITIP and NTIP groups based on the anatomical location of the dominant perforator. Preoperative CTA was used to identify perforator course. Intraoperatively, dissection time was recorded. Flap perfusion was quantitatively assessed using fluorescence imaging, and postoperative complications were monitored for 6 months. RESULTS:In this retrospective study, we found that although ITIP required longer dissection time, they provided reliable perfusion without increasing complication rates. Maximum correlation analysis found that the y-axis distance of ITIP had the strongest correlation with the dissection time. CONCLUSION:ITIP flaps appreciate sufficient blood perfusion compared with NTIP flaps, and the incidence of complications is not increased, making it a feasible candidate for DIEP breast reconstruction. LEVEL OF EVIDENCE IV:This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors.

There is a lack of reliable evidence on the surgical outcomes of profunda artery perforator (PAP) flap breast reconstruction. We conducted a meta-analysis to evaluate its safety and compare it with deep inferior epigastric perforator (DIEP) flap, aiming to offer more information on whether the PAP flap was an ideal alternative for autologous breast reconstruction. PubMed, EMBASE, Web of Science and Cochrane Library were searched to retrieve relevant articles. The postoperative complication rates following PAP reconstruction were pooled. Mean differences of patients’ age, BMI, mastectomy weight and flap weight between PAP and DIEP group were calculated, and relative risk was estimated to compare their incidence of complications. Twenty-four articles reporting 1612 PAP flap breast reconstructions were included. The surgical success rate was 99.6 www.springer.com/00266 .

Background: Ischemic necrosis in the distal portion of the flap is a challenging complication in plastic surgery. We hypothesize a novel hybrid flap preconditioning (HFP) device combining foam-mediated external suction and non-surgical delay can promote skin flap survival better than surgical delay. Method: Twenty-eight mouse were divided into four groups. Control group: a 4*1.5 dorsal flap was made with no preconditioning. Surgical delay (SD) group: surgical delay was made 7 days before flap elevation. Foam-mediated external suction (FMES) group: foam-mediated external suction at -100mmHg was employed 5 hours per day for 6 days, and the flap was elevated on the seventh day. Hybrid Flap Preconditioning (HFP) group: silicone strips was applied along the contour of the foam interface. Same negative pressure protocol was used as the FMES group. Seven days after flap elevation, macroscopic, histologic, and Western blot analyses were performed. Results: The flap survival rate was 46.25% (8.12%) in the control group, 68.72% (7.00%) in the SD group, 57.03% (8.17%) in the FMES group and 80.66% (3.27%) in the HFP group. Immunohistologic analysis of CD 31+ cell in distal end of viable tissue procured seven days after flap elevation showed a significantly higher angiogenesis in SD group and HFP group. Western Blot results showed an increased expression of VEGF in SD group and HFP group. Conclusion: We have developed and fabricated a novel hybrid flap precondition (HFP) device combining foam-mediated external suction and non-surgical delay. The concept of HFP is proved to promote flap survival better than surgical delay.

For females in puberty, mastectomy caused by pathological gigantomastia usually brings significant psychological problems. Appropriate immediate breast reconstruction method is necessary. The aim of this study is to present a novel method of breast reconstruction that requires neither implants nor donor-site sacrifice. All patients who were diagnosed with pathological gigantomastia and indicated for nipple-sparing or skin-sparing mastectomy (NSM or SSM) were selected. All extra skin was de-epithelialized, followed by NSM or SSM through a vertical incision on the lower pole of the breast. Then, a skin and dermal envelope in all directions was formed. Whether to preserve the nipple–areolar complex depended on its perfusion. The dermal flap was folded inward to serve as the “autologous dermal filler” and reconstruct the breast. A second surgery of inframammary fold elevation for larger projection was performed at least 6 months. Follow up for at least 1 year and record complications as well as pre- and postoperative BREAST-Q Scores. A total of 11 breasts were included. Four (36.4 www.springer.com/00266 .

Oxidative stress (OXS) is closely related to tumor prognosis and immune response, while TP53 integrated with NRF2 is closely associated with the regulation of cancer-related OXS. Hence, constructing a TP53-NRF2 integrated OXS signature of pan-cancer is essential in predicting survival prognosis and facilitating cancer drug treatment. The pan-cancer analysis acquired the Cancer Genome Atlas (TCGA) transcriptome sequencing data from UCSC Xena, which consisted of 33 cancer types (n = 10 440). The Random Forest, Lasso regression, and Cox regression analyses are used to construct an OXS score based on 25 OXS genes. Following this, based on the OXS signature, patients are categorized into low- and high-risk groups. The disparities between the two cohorts regarding survival prognosis, immune infiltration, and drug sensitivity are delved deeply. The expression level of genes is confirmed using immunohistochemistry. The prognosis of pan-cancer patients is adequately predicted by the OXS signature with the assistance of the machine-learning algorithm. A highly accurate nomogram is developed by combining the OXS signature and clinical features. The presence of immune cells indicated that the OXS signature can be associated with the critical pathways of immunotherapy for all types of cancer, and BCL2 showed promising results. Distinct inter-group differences are observed in the OXS signature for frequently utilized antineoplastic medications in clinical settings, including first-line drugs suggested in the guidelines. In summary, by conducting a thorough analysis of OXS genes, a new model based on OXSscore is successfully developed. This model can predict the clinical prognosis and drug sensitivity of pan-cancer with high accuracy. Potential stars in the field of cancer-related anti-OXS may include drugs that target BCL2.

Abstract Objective This study aims to investigate the association between specific lipidomes and the risk of breast cancer (BC) using the Two-Sample Mendelian Randomization (TSMR) approach and Bayesian Model Averaging Mendelian Randomization (BMA-MR) method. Method The study analyzed data from large-scale GWAS datasets of 179 lipidomes to assess the relationship between lipidomes and BC risk across different molecular subtypes. TSMR was employed to explore causal relationships, while the BMA-MR method was carried out to validate the results. The study assessed heterogeneity and horizontal pleiotropy through Cochran's Q, MR-Egger intercept tests, and MR-PRESSO. Moreover, a leave-one-out sensitivity analysis was performed to evaluate the impact of individual single nucleotide polymorphisms on the MR study. Results By examining 179 lipidome traits as exposures and BC as the outcome, the study revealed significant causal effects of glycerophospholipids, sphingolipids, and glycerolipids on BC risk. Specifically, for estrogen receptor-positive BC (ER+ BC), phosphatidylcholine (P < 0.05) and phosphatidylinositol (OR: 0.916–0.966, P < 0.05) within glycerophospholipids play significant roles, along with the importance of glycerolipids (diacylglycerol (OR = 0.923, P < 0.001) and triacylglycerol, OR: 0.894–0.960, P < 0.05)). However, the study did not observe a noteworthy impact of sphingolipids on ER+BC. In the case of estrogen receptor-negative BC (ER− BC), not only glycerophospholipids, sphingolipids (OR = 1.085, P = 0.008), and glycerolipids (OR = 0.909, P = 0.002) exerted an influence, but the protective effect of sterols (OR: 1.034–1.056, P < 0.05) was also discovered. The prominence of glycerolipids was minimal in ER-BC. Phosphatidylethanolamine (OR: 1.091–1.119, P < 0.05) was an important causal effect in ER−BC. Conclusions The findings reveal that phosphatidylinositol and triglycerides levels decreased the risk of BC, indicating a potential protective role of these lipid molecules. Moreover, the study elucidates BC's intricate lipid metabolic pathways, highlighting diverse lipidome structural variations that may have varying effects in different molecular subtypes.

The adipogenic property of decellularized adipose-derived matrix (DAM) varies widely across reports, making it difficult to make a horizontal comparison between reports and posing challenges for the stable clinical translation of DAM. It is possibly due to differences in donor characteristics, but the exact relationship remains unclear. Despite extensive research on the differences between superficial and deep layers of abdominal subcutaneous fat, a main donor of DAM, little is known about their extracellular matrix (ECM) which is promising in regenerative medicine. In this study, we first confirmed the distinct compositional profiles and adipogenic potential between superficial and deep DAM (S-DAM and D-DAM). Both in vitro and in vivo assays confirmed superior adipogenic induction potential in S-DAM over D-DAM. Total amounts of ECM proteins like collagen and laminin were similar, however, the predominant types differed, with collagen I dominating S-DAM and collagen XIV prevailing in D-DAM. S-DAM was enriched with mitochondrial and immunological proteins, whereas D-DAM featured more neuronal, vascular, muscular, and endocrine-related proteins. More proteins involved in mRNA processing were found in D-DAM, with Protein-Protein Interaction (PPI) analysis revealing HNRNPA2B1, HNRNPA1, and HNRNPC as the most tightly interacting members. These findings not only deepen our comprehension of the structural and functional heterogeneity of adipose tissues but also become one of the reason for the large variability between batches of DAM products, providing guidance for constructing more efficient and stable bio-scaffolds.

Decellularized adipose-derived matrix (DAM) has emerged as a promising biomaterial for soft tissue reconstruction. However, due to a lack of research on its complex composition, the understanding of the key components in DAM remains limited, leading to inconsistent adipogenic properties and challenges in optimizing preparation methods purposefully. In this study, it is proposed for the first time that DAM comprises two distinct components: hydrophilic (H-DAM) and lipophilic (L-DAM), each with markedly different effects on fat regeneration. It is confirmed that H-DAM is the key component for inducing fat regeneration due to its enhanced cell-cell and cell-scaffold interactions, primarily mediated by the Hedgehog signaling pathway. In contrast, L-DAM exhibits poor cell adhesion and contains more antigenic components, leading to a higher immunoinflammatory response and reduced adipogenesis. In addition, it is found that intracellular proteins, which are more abundant in H-DAM, can be retained as beneficial components due to their hydrophilicity, contrary to the conventional view that they shall be removed. Accordingly, a purified bioscaffold with unprecedented efficacy is proposed for fat regeneration and reduced immunogenicity. This finding provides insights for developing scaffolds for fat regeneration and promotes the realization of xenotransplantation.

Background:T-helper cells play an essential role in the progression of lymphedema. This study aimed to explore the biological significance of T-helper cell-associated genes (THAGs) in a mouse tail model of lymphedema by RNA-sequencing (RNA-seq) data.Methods:The expression profiles of a murine model of secondary lymphedema were obtained from European Nucleotide Archive (ENA) database. Differentially expressed genes (DEGs) were screened and the enrichment analysis of DEGs was conducted. THAGs were constructed by crossing the T-helper-related gene sets obtained from Molecular Signatures Database with DEGs. Protein-protein interaction (PPI) network analysis was utilized to establish T-helper-associated hub genes (THAHGs). Single-sample gene set enrichment analysis (ssGSEA) was employed to decipher differences in immune cell infiltration. The correlation between THAHGs and immune infiltration was calculated by Pearson correlation analysis. Receiver operating characteristic (ROC) curves of THAHGs were drawn to evaluate their diagnostic properties. Additionally, potential drugs and upstream transcription factors (TFs) were predicted based on THAHGs.Results:Enrichment analysis showed that lymphedematous tissue presented higher activation of biological process (BP) of T-helper 1 (Th1), T-helper 2 (Th2), T-helper 17 (Th17). The immune infiltration analysis further calculated that the relative immune abundance of follicular B cells, memory B cells, M1 macrophage, and CD4+ Tm cells was significantly elevated while the relative immune abundance of neutrophils and plasma cells were down-regulated in lymphedema. We established a list of THAHGs consisting of eight hub genes, compassing Cd4, Foxp3, Irf4, Ccr6, Il12rb1, Batf, Il1b, Cd74. THAHGs were shown to be significantly interrelated and related to immune infiltration by Pearson correlation analysis. ROC curves showcased that the area under curve (AUC) values of THAHGs were larger than 0.70. Gata3 was the most potential TF and thalidomide might be the immunoregulatory drug for lymphedema based on THAHGs.Conclusions:Biological pathways associated with T-helpers were significantly enriched in mouse lymphedema tissue. The relative immune infiltration abundance of M1 macrophage, CD4+ Tm cells, and T-helper cells was higher in the lymphedema group. Besides, we identified the THAHGs containing eight genes, namely, Cd4, Foxp3, Irf4, Ccr6, Il12rb1, Batf, Il1b, and Cd74. The THAHGs were closely correlated with immune infiltration results and with good diagnostic properties.