Liposuction Treatment of Lymphedema

Abstract

In the Western world, lymphedema most commonly occurs following treatment of cancer. Limb reductions have been reported utilizing various conservative therapies including manual lymph and pressure therapy, as well as by microsurgical reconstruction involving lymphovenous shunts and transplantation of lymph vessels or nodes. Failure of these conservative and surgical treatments to provide complete reduction in patients with long-standing pronounced lymphedema is due to the persistence of excess newly formed subcutaneous adipose tissue in response to slow or absent lymph flow, which is not removed in patients with chronic non-pitting lymphedema. Traditional surgical regimes utilizing bridging procedures, total excision with skin grafting, or reduction plasty seldom achieved acceptable cosmetic and functional results. Liposuction removes the hypertrophied adipose tissue and is a prerequisite to achieve complete reduction, and this reduction is maintained long-term through constant (24 h) use of compression garments postoperatively. This article describes the techniques and evidence basis for the use of liposuction for treatment of lymphedema.

Keywords: adipose tissue; fat; liposuction; lymphedema.

Fig. 1

( a ) A 74-year-old woman with non-pitting arm lymphedema lasting for 15 years following breast cancer treatment. Preoperative excess volume was 3,090 mL. ( b ) Postoperative result.

Fig. 2

( a ) Primary lymphedema: preoperative excess volume 6,630mL. (b) Postoperative result with complete reduction after 2 years.

Fig. 3

Liposuction of arm lymphedema. The procedure takes ∼2 hours. From preoperative to postoperative state ( left to right ). Note the tourniquet, which has been removed at the right, and the concomitant reactive hyperemia.

Fig. 4

( a ) Marked lymphedema of the arm after breast cancer treatment, showing pitting several centimeters in depth (grade I edema). The arm swelling is dominated by the presence of fluid, i.e., the accumulation of lymph. ( b ) Pronounced arm lymphedema after breast cancer treatment (grade II edema). There is no pitting in spite of hard pressure by the thumb for 1 minute. A slight reddening is seen at the two spots where pressure has been exerted. The “edema” is completely dominated by adipose tissue. The term “edema” is unsuitable at this stage since the swelling is dominated by hypertrophied adipose tissue and not by lymph. At this stage, the aspirate will contain either no, or a minimal amount, of lymph.