Patient-Reported Outcomes of Liposuction for Lipedema Treatment

Abstract

Background: Lipedema, as a disabling and consequential disease, is gaining more awareness due to its potential omnipresence. Patients suffering from lipedema show a characteristic painful display of symmetric accumulations of adipose tissue. The combination of swelling, pain and decreased quality of life (QOL) is outstanding for the diagnosis. The aim of this study was to identify the effect of liposuction in terms of the QOL for patients and underline important factors of current and pending research regarding surgical therapy of lipoedema.

Methods: Patients suffering from lipedema prior to and after receiving liposuction at our hospital were included in this study. Patients completed a lipedema-specific self-designed 50 item questionnaire: the World Health Organization Quality of Life BREF (WHOQOL-BREF) and the Patient Health Questionnaire 9 (PHQ-9). A linear mixed model was used for outcome analysis.

Results: In total, 511 patients completed a questionnaire prior to the surgery at primary presentation to the hospital and a total number of 56 patients completed a questionnaire after liposuction. A total of 34 of these patients filled in both questionnaires prior to and after surgery. The general characteristics of the disease, such as daily symptoms and psychological health, pertinently improved after surgery.

Conclusions: Liposuction can have a general improving effect on the QOL of patients, both in private and professional life. Liposuction may currently be the most evident and promising method in the treatment of lipedema.

Keywords: PHQ-9; QOL; WHOQOL-BREF; lipedema; liposuction; restrictions in daily life.

Figure A1

Shows the self-designed follow-up questionnaire which is filled out by each lipedema patient after surgery.

Figure 1

Lipedema stages at initial presentation and when undergoing surgery. At initial presentation, 8.6% of patients presented with stage one lipedema, 57.8% with stage two and 33.6% with stage three lipedema. At presentation for surgery, 3.65% of patients presented with stage one, 34.5% with stage two and 61.8% with stage three lipedema.

Figure 2

Pain in affected areas prior and after surgery. (a) Prior to surgery, patients showed a mean of 6.68 (±2.29). (b) Patients after surgery showed a mean of 4.29 (±2.16).

Figure 3

PHQ-9 value prior to and after surgery. (a) Prior to surgery, a mean value of 10.84 (±6.39) insinuates moderate to severe depression. (b) After surgery, the mean value is 8.27 (±6.45), indicating a mild depressive mood. (c) Differences in depression rates in correlation to the stages of lipedema comparing before and after surgery.

Figure 4

WHOQOL-BREF domains. (a) The mean value of the physical domain was 54.54 (±20.10) prior to surgery. (b) After surgery, the mean value for the physical domain was 60.33 (±19.98). (c) The psychological domain prior to surgery had a mean of 51.85 (±18.67). (d) After surgery, the mean for the psychological domain was 57.51(±18.31). (e) The social domain prior to surgery obtained a mean of 63.72 (±23.05). (f) After surgery, the mean of the social domain was 68.42 (±20.23). (g) Prior to surgery, the environmental domain had a mean of 71.85 (±16.00). (h) After surgery, the mean for the environmental domain was 74.50 (±16.06).

Figure 4

WHOQOL-BREF domains. (a) The mean value of the physical domain was 54.54 (±20.10) prior to surgery. (b) After surgery, the mean value for the physical domain was 60.33 (±19.98). (c) The psychological domain prior to surgery had a mean of 51.85 (±18.67). (d) After surgery, the mean for the psychological domain was 57.51(±18.31). (e) The social domain prior to surgery obtained a mean of 63.72 (±23.05). (f) After surgery, the mean of the social domain was 68.42 (±20.23). (g) Prior to surgery, the environmental domain had a mean of 71.85 (±16.00). (h) After surgery, the mean for the environmental domain was 74.50 (±16.06).

Figure 5

Patient satisfaction after surgery. 1 = very satisfied, 2 = satisfied, 3 = moderately satisfied, 4 = not at all, 5 = deterioration. The mean value of 56 patients was 2.00 (±0.98).