Liposuction gives complete reduction of chronic large arm lymphedema after breast cancer

Abstract

About one-third of all women treated for breast cancer develop arm lymphedema. In addition to the worry of the cancer itself, the swollen and heavy arm is both a physical and a psychosocial handicap for the patients. Previous surgical and conservative treatments have not always given satisfactory and permanent results, conceivably because lymphedema causes hypertrophy of the subcutaneous adipose tissue. From this point of view, liposuction (LS) combined with Controlled Compression Therapy (CCT) is an interesting approach, as the hypertrophied adipose tissue is effectively removed and the outcome sustained by wearing a compression garment. Pre- and postoperative arm edema volumes were measured using the water displacement technique. Skin blood flow was recorded using Laser Doppler imaging. Lymph transport in the arm was assessed by indirect lymphoscintigraphy. LS + CCT reduced the arm edema volume completely, compared with a 50% decrease following CCT alone. The use of a compression garment after liposuction is necessary in order to maintain the normalized arm volume. LS + CCT did not affect the already impaired lymph transport; it merely increased skin microcirculation. A reduced incidence of cellulitis was noted.