Complete reduction of lymphoedema of the arm by liposuction after breast cancer

Abstract

The incidence of lymphoedema of the arm after mastectomy ranges between 8% and 38%, and it is an appreciable problem from both functional and social aspects. Conservative and previous surgical regimens have not been completely successful. In the light of these experiences, liposuction clearly constitutes an interesting new surgical approach, which is potentially capable of effecting predictable and reliable improvements in patients with lymphoedema. Twenty eight women with lymphoedema of the arm after breast cancer were consecutively treated by liposuction. Limb compression with a compression garment was instituted immediately after operation. All patients had been given radiotherapy after the operation for breast cancer. Mean preoperative volume of oedema was 1845 ml (range 570-3915), and mean volume of aspirate was 2250 ml (range 1000-3850); volume of aspirate correlated linearly with the volume of preoperative oedema. There were no major surgical complications, but blood transfusion was necessary in eight patients whose volume of aspirate exceeded 2000 ml. After 12 months (n = 24), an average reduction in volume of oedema of 106% was found. Such a normalisation can be expected in patients with oedema that amounts to about 2500 ml. Although the oedema cannot be completely removed in more severe cases, substantial reduction is beneficial from both functional and cosmetic aspects. We conclude that liposuction is safe and effective for reducing lymphoedema of the arm after operations for breast cancer. In a one-stage procedure, oedematous and hypertrophic fat tissue can be removed with an excellent clinical outcome.