Subscribe to RSS
DOI: 10.1055/s-0035-1549158
Liposuction in Lymphedema Treatment
Publication History
08 January 2015
04 February 2015
Publication Date:
20 April 2015 (online)
Abstract
Background Lymphedema leads to early deposition of adipose tissue. This may explain why conservative therapies such as complex decongestive therapy (CDT) and controlled compression therapy (CCT), as well as various forms of microsurgical reconstructions, cannot completely remove the excess volume in patients with a large chronic nonpitting lymphedema. Liposuction is therefore a logical and tempting treatment to reduce the adipose tissue volume excess. This article outlines the benefits of using liposuction and presents evidence to support its use.
Methods The mechanism between adipose tissue depositions is described as well as the surgical technique, postoperative care, volume measurements, effects on the lymph transport, and follow-up.
Results Fifteen years' follow-up shows complete reduction of the excess volume without recurrence following liposuction in patients with postmastectomy arm lymphedema. The same promising results can also be seen in patients with leg lymphedema.
Conclusion Various types of treatment of lymphedema are under discussion and there has been some controversy regarding liposuction for lymphedema. Improvements in techniques, patient preparation, and patient follow-up have led to a greater and wider acceptance of liposuction as a treatment for lymphedema in patients with large chronic nonpitting extremity lymphedemas.
-
References
- 1 Brorson H, Ohlin K, Olsson G, Svensson B. Liposuction of leg lymphedema: preliminary 2 year results. Lymphology 2007; 40 (Suppl): 250-252
- 2 Brorson H, Ohlin K, Olsson G, Svensson B. Long term cosmetic and functional results following liposuction for arm lymphedema: an eleven year study. Lymphology 2007; 40 (Suppl): 253-255
- 3 Segerström K, Bjerle P, Graffman S, Nyström A. Factors that influence the incidence of brachial oedema after treatment of breast cancer. Scand J Plast Reconstr Surg Hand Surg 1992; 26 (2) 223-227
- 4 Petrek JA, Senie RT, Peters M, Rosen PP. Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis. Cancer 2001; 92 (6) 1368-1377
- 5 Mansel RE, Fallowfield L, Kissin M , et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst 2006; 98 (9) 599-609
- 6 Olszewski WL. Lymph Stasis: Pathophysiology, Diagnosis and Treatment. Boca Raton, FL: CRC Press; 1991: 648
- 7 Johansson K, Piller N. Weight-bearing exercise and its impact on arm lymphedema. J Lymphoedema 2007; 2 (1) 15-22
- 8 Ridner SH. Quality of life and a symptom cluster associated with breast cancer treatment-related lymphedema. Support Care Cancer 2005; 13 (11) 904-911
- 9 Piller NB, Thelander A. Treatment of chronic postmastectomy lymphedema with low level laser therapy: a 2.5 year follow-up. Lymphology 1998; 31 (2) 74-86
- 10 Brorson H, Ohlin K, Olsson G, Långström G, Wiklund I, Svensson H. Quality of life following liposuction and conservative treatment of arm lymphedema. Lymphology 2006; 39 (1) 8-25
- 11 Brorson H, Svensson H. Complete reduction of lymphoedema of the arm by liposuction after breast cancer. Scand J Plast Reconstr Surg Hand Surg 1997; 31 (2) 137-143
- 12 Brorson H, Svensson H. Liposuction combined with controlled compression therapy reduces arm lymphedema more effectively than controlled compression therapy alone. Plast Reconstr Surg 1998; 102 (4) 1058-1067 , discussion 1068
- 13 Rockson SG, Miller LT, Senie R , et al. American Cancer Society Lymphedema Workshop. Workgroup III: Diagnosis and management of lymphedema. Cancer 1998; 83 (12 Suppl American): 2882-2885
- 14 Ryan TJ. Lymphatics and adipose tissue. Clin Dermatol 1995; 13 (5) 493-498
- 15 Sadler D, Mattacks CA, Pond CM. Changes in adipocytes and dendritic cells in lymph node containing adipose depots during and after many weeks of mild inflammation. J Anat 2005; 207 (6) 769-781
- 16 Pond CM. Adipose tissue and the immune system. Prostaglandins Leukot Essent Fatty Acids 2005; 73 (1) 17-30
- 17 Borley NR, Mortensen NJ, Jewell DP, Warren BF. The relationship between inflammatory and serosal connective tissue changes in ileal Crohn's disease: evidence for a possible causative link. J Pathol 2000; 190 (2) 196-202
- 18 Harvey NL, Srinivasan RS, Dillard ME , et al. Lymphatic vascular defects promoted by Prox1 haploinsufficiency cause adult-onset obesity. Nat Genet 2005; 37 (10) 1072-1081
- 19 Schneider M, Conway EM, Carmeliet P. Lymph makes you fat. Nat Genet 2005; 37 (10) 1023-1024
- 20 Brorson H, Åberg M, Svensson H. Chronic lymphedema and adipocyte proliferation: clinical therapeutic implications. Lymphat Res Biol 2003; 1 (1) 88
- 21 Damstra RJ, Voesten HG, Klinkert P, Brorson H. Circumferential suction-assisted lipectomy for lymphoedema after surgery for breast cancer. Br J Surg 2009; 96 (8) 859-864
- 22 Schaverien MV, Munro KJ, Baker PA, Munnoch DA. Liposuction for chronic lymphoedema of the upper limb: 5 years of experience. J Plast Reconstr Aesthet Surg 2012; 65 (7) 935-942
- 23 Brorson H, Ohlin K, Olsson G, Karlsson MK. Breast cancer-related chronic arm lymphedema is associated with excess adipose and muscle tissue. Lymphat Res Biol 2009; 7 (1) 3-10
- 24 Brorson H, Ohlin K, Olsson G, Nilsson M. Adipose tissue dominates chronic arm lymphedema following breast cancer: an analysis using volume rendered CT images. Lymphat Res Biol 2006; 4 (4) 199-210
- 25 Bagheri S, Ohlin K, Olsson G, Brorson H. Tissue tonometry before and after liposuction of arm lymphedema following breast cancer. Lymphat Res Biol 2005; 3 (2) 66-80
- 26 Jones B, Fishman EK, Hamilton SR , et al. Submucosal accumulation of fat in inflammatory bowel disease: CT/pathologic correlation. J Comput Assist Tomogr 1986; 10 (5) 759-763
- 27 Sheehan AL, Warren BF, Gear MW, Shepherd NA. Fat-wrapping in Crohn's disease: pathological basis and relevance to surgical practice. Br J Surg 1992; 79 (9) 955-958
- 28 Lantz M, Vondrichova T, Parikh H , et al. Overexpression of immediate early genes in active Graves' ophthalmopathy. J Clin Endocrinol Metab 2005; 90 (8) 4784-4791
- 29 Zampell JC, Aschen S, Weitman ES , et al. Regulation of adipogenesis by lymphatic fluid stasis: part I. Adipogenesis, fibrosis, and inflammation. Plast Reconstr Surg 2012; 129 (4) 825-834
- 30 Aschen S, Zampell JC, Elhadad S, Weitman E, De Brot M, Mehrara BJ. Regulation of adipogenesis by lymphatic fluid stasis: part II. Expression of adipose differentiation genes. Plast Reconstr Surg 2012; 129 (4) 838-847
- 31 Damstra RJ, Voesten HGJ, van Schelven WD, van der Lei B. Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature. Breast Cancer Res Treat 2009; 113 (2) 199-206
- 32 Campisi C, Bellini C, Campisi C, Accogli S, Bonioli E, Boccardo F. Microsurgery for lymphedema: clinical research and long-term results. Microsurgery 2010; 30 (4) 256-260
- 33 Maegawa J, Hosono M, Tomoeda H, Tosaki A, Kobayashi S, Iwai T. Net effect of lymphaticovenous anastomosis on volume reduction of peripheral lymphoedema after complex decongestive physiotherapy. Eur J Vasc Endovasc Surg 2012; 43 (5) 602-608
- 34 Brorson H, Svensson H, Norrgren K, Thorsson O. Liposuction reduces arm lymphedema without significantly altering the already impaired lymph transport. Lymphology 1998; 31 (4) 156-172
- 35 Brorson H. From lymph to fat: liposuction as a treatment for complete reduction of lymphedema. Int J Low Extrem Wounds 2012; 11 (1) 10-19
- 36 Brorson H, Ohlin K, Olsson G, Svensson B, Svensson H. Controlled compression and liposuction treatment for lower extremity lymphedema. Lymphology 2008; 41 (2) 52-63
- 37 Brorson H, Freccero C, Ohlin K , et al. Liposuction normalizes elephantiasis of the leg - a prospective study with a 6 year follow-up. Eur J Lymphol 2009; 41: 52-63
- 38 Clayton DN, Clayton JN, Lindley TS, Clayton JL. Large volume lipoplasty. Clin Plast Surg 1989; 16 (2) 305-312
- 39 Klein JA. The tumescent technique for liposuction surgery. Am J Cosmet Surg 1987; 4: 263-267
- 40 Wojnikow S, Malm J, Brorson H. Use of a tourniquet with and without adrenaline reduces blood loss during liposuction for lymphoedema of the arm. Scand J Plast Reconstr Surg Hand Surg 2007; 41 (5) 243-249
- 41 Baumeister RG, Siuda S. Treatment of lymphedemas by microsurgical lymphatic grafting: what is proved?. Plast Reconstr Surg 1990; 85 (1) 64-74 , discussion 75–76
- 42 Andersen L, Højris I, Erlandsen M, Andersen J. Treatment of breast-cancer-related lymphedema with or without manual lymphatic drainage—a randomized study. Acta Oncol 2000; 39 (3) 399-405
- 43 Campisi C, Davini D, Bellini C , et al. Lymphatic microsurgery for the treatment of lymphedema. Microsurgery 2006; 26 (1) 65-69
- 44 Baumeister RGH, Frick A. The microsurgical lymph vessel transplantation [in German]. Handchir Mikrochir Plast Chir 2003; 35 (4) 202-209
- 45 Brorson H. Liposuction in arm lymphedema treatment. Scand J Surg 2003; 92 (4) 287-295
- 46 Brorson H, Svensson H. Skin blood flow of the lymphedematous arm before and after liposuction. Lymphology 1997; 30 (4) 165-172