Lymphedema Leads to Fat Deposition in Muscle and Decreased Muscle/Water Volume After Liposuction: A Magnetic Resonance Imaging Study

Abstract

Background: Lymphedema leads to adipose tissue deposition. Water-fat magnetic resonance imaging (MRI) can quantify and localize fat and water. The presence of excess fat and excess water/muscle in the subfascial compartment of the lymphedematous limb has not been investigated before. The aim of this study was to investigate epifascial and subfascial fat and water contents in patients with chronic lymphedema before and after liposuction.

Methods and results: Seven patients with arm lymphedema and six with leg lymphedema were operated on. The limbs were examined with water-fat MRI before liposuction (baseline) and at five time points. Complete reduction of the excess limb volumes was achieved. The excess epifascial fat was evident in the edematous limbs and a drop was seen following surgery. There were differences in excess water at all time points. At 1 year there was a decrease in excess water. Excess subfascial fat was seen in the edematous limbs at all time points. Subfascial excess water/muscle did not show any differences after surgery. However, starting from 3 months there was less subfascial water/muscle compared with baseline.

Conclusions: Subfascial fat in the lymphedematous limbs did not change. In contrast, the water in the subfascial compartment was reduced over time, which may represent a decrease of muscle volume after treatment due to less mechanical load after liposuction. Using water-fat MRI-based fat quantification, the fat and water contents may be quantified and localized in the various compartments in lymphedema.

Keywords: MRI; adipose tissue; fat; liposuction; lymphedema; water–fat imaging.

FIG. 1.

Relative excess total limb volume (%). A significantly larger excess epifascial fat volume was seen in the edematous limbs at baseline and at 2 weeks and 1 month after surgery. No significant difference between limbs was seen at 3 months, 6 months, and 1 year after surgery (lower asterisks). A significant drop in total excess limb volumes remained for all postoperative time points compared with baseline (upper asterisks). *p < 0.05, **p < 0.01, ***p < 0.001.

FIG. 2.

Relative excess epifascial fat volume (%). A significantly larger excess epifascial fat volume was seen in the edematous limbs at baseline. Following surgery a significantly lower excess epifascial fat volume was noted in the edematous limbs at all time points (lower asterisks). A significant drop in epifascial excess fat volume remained for all postoperative time points compared with baseline (upper asterisks). No difference in the fat volume was seen between the extremities in healthy controls. **p < 0.01, ***p < 0.001.

FIG. 3.

Relative excess epifascial water volume (%). A significantly larger excess epifascial water volume was seen in the edematous limbs at baseline and at all time points after surgery (lower asterisks). No significant change in the excess water volume was seen compared with baseline until after 1 year, where a smaller excess epifascial water volume was seen (upper asterisks). No difference in the water volume was seen between the extremities in healthy controls. **p < 0.01, ***p < 0.001.

FIG. 4.

Relative excess subfascial fat volume (%). A significantly larger excess volume of subfascial fat was seen in the edematous limbs at all time points. No significant change in the excess subfascial fat was seen compared with baseline at any time. No difference in the subfascial fat volume was seen between the extremities in healthy controls. *p < 0.05, **p < 0.01, ***p < 0.001.

FIG. 5.

Relative excess subfascial water/muscle volume (%). No significant difference in relative subfascial excess water/muscle volume between the limbs was detected at any time point. Following surgery a significant drop in the subfascial excess water/muscle volume was seen at 3 months, 6 months, and 1 year compared with baseline. No difference in excess water/muscle volume was seen between the extremities in healthy controls. *p < 0.05, **p < 0.01, ***p < 0.001.