LYMPHEDEMA LIPOSUCTION TREATMENT
This page has been updated and replaced. For current information please see:
May 20, 2008
A new and still somewhat controversial treatment for lymphedema has emerged from Sweden. Head of the lymphedema unit in the department of plastic and reconstructive surgery at Malmo University Hospital, Dr. Hakan Brorson reports that in the 70 lymphedema patients he treated with this method said that his patients had complete reduction of swelling with no recurrence.
Despite that he does recommend to patients that they continue therapy which includes wearing controlled compression bandages.
Candidates for the procedure are person with severe lymphedema with no pitting and who have been nonresponsive to other therapies.
Its controversial because of the fact he makes 15 to 20 small incisions on the arm. Of course this type of invasive procedure opens the arm up to be at high risk for an infectious complication. He also has reported that there have been no such occurrences.
As of our update of January 11, 2012, there have been no further studies to clinically confirm the long term safety of liposuction for lymphedema. I remain skeptical therefore to using it. The short term results may still not be worth the long term risks. Plus, it is evident that even though one has liposuction, you will still need to wear the compression garment for the remainder of your life. So, my question is, “What exactly was gained?”
We need follow up studies for ten, twelve or even fifteen years.
Finally, I did run across this interesting comment by a Board Certified Seattle Plastic Surgeon on the use of liposuction for lymphedema. In a question and answer forum he states: “This is not a good idea. Twenty (20) years ago, a plastic surgeon I was training with did studies on the treatment of lymphedema with liposuction. Early successes were just from fluid removal. The hope was that scar tissue would inhibit the recurrence of the edema but that did not happen. This plus the difficulty fighting infection in the face of lymphedema make liposuction in this setting not a good idea.”
Another doctor in the same forum states: “This is a tough question. My general inclination is to discourage the use of this technique for this problem. Lymphedematous arms are more prone to infection and poor wound healing due to increased tissue fluids and impaired oxygen diffusion through the tissues. However, I am aware, as no doubtedly you are, that there are reports of improvement with this modality. If you are considering this, I would highly recommend a specialist who has vast experience in treating patients. At the very…”
were two other doctors who made the same comments of NOT DOING it in
this forum. This makes four against and none recommending liposuction
on a lymphedematous limb.
Liposuction Treatment of Lymphedema
A new method for treatment of chronic lymphedema of the arm after a radical mastectomy
Liposuction Reduces Arm Lymphedema Without Significantly Altering the Already Impaired Lymph Transport
Swedish Physician Uses Liposuction to Help Treat Lymphedema (dateline April 20, 2001)
Swedish Doctor Uses Liposuction
NATIONAL LYMPHEDEMA NETWORK
Questions and Answers
Q: Recently I read an article in the NY Post about liposuction for lymphedema in the arm after Breast cancer surgery. As you can imagine, after living with this condition for many years, I was very excited, but not sure where to get further information. Is it true that liposuction can reverse and cure the swelling in my arm? Where can I go for surgery? My doctor was not able to help me. Anxious to hear from you, a long time NLN Member.
A: Liposuction is not a cure for lymphedema. At the present time, there is NO cure for lymphedema. The information you read about refers to a procedure done in Sweden by a Dr. Brorson. He presented this information at the NLN Conference in Orlando this year. He was clear throughout his presentation that he only performs this procedure on long standing, fibrotic, post-mastectomy lymphedema of the arm.
Dr. Brorson emphasized that CDT (combined decongestive therapy), which consists of manual lymph drainage, compression bandaging, skin care, exercise, and self care instruction is still the treatment of choice for lymphedema. He only recommends this liposuction procedure to individuals who could not receive treatment and have developed severe, long-standing, fibrotic lymphedema. He emphasized that after this procedure, the individual must wear compression garments daily and compression bandages nightly, forever. The procedure does not correct the inadequate lymph drainage. It removes large amounts of fibrous tissue from the limb, and necessitates a lengthy operation with extensive scarring.
While it may indeed reduce the overall girth of a very large, fibrotic limb a bit more than a course of CDT by virtue of the fact that the surgeon removes large amounts of subcutaneous tissue, the success of the follow-up home program for both therapies is determined by the compliance of the patient with wearing constant compression on the involved limb and doing the recommended exercise/self-massage program. After the surgery, if an individual decides s/he no longer wants to wear the compression garments/bandages, the limb is at extreme risk of swelling and ballooning out of shape due to the removal of the connective tissue structure of the limb with the liposuction.
This procedure is not without significant surgical risks posed by anesthesia, risk of fat emboli, and risk of post operative wound infection (in a limb with an impaired immune system due to lymph node dissection/radiation therapy). It is distressing to think that a medical insurance plan would probably be willing to pay large fees for liposuction as a "surgical correction for lymphedema" while possibly denying payment for the safer, less expensive course of CDT. Dr. Brorson was the first to say that his first recommendation to an individual with lymphedema post mastectomy, is a course of CDT. Too bad that the reporters who attended the NLN conference chose only to highlight this radical surgical approach to advanced lymphedema. Too bad they missed an opportunity to educate the public about CDT which is safe, non-invasive, and very successful in reducing and managing lymphedema, which to date, has no cure.
*'Liposuction' to ease surgery side-effect*
Liposuction is usually employed to remove excess fat from the stomach or thighs, but a Swedish surgeon, Haken Brorson, is tackling a condition called lymphoedema.
However, a UK support group believes that the technique may hold dangers for the patient.
The lymphatic system is a circulatory system which redistributes excess fluids and dead cells around the body.
Women whose cancer requires the removal of lymph glands in the armpits - which can harbour cancer cells - can find the flow of lymph is disrupted.
This can cause, in some cases, an increase in the volume of fatty tissue in the arm, which is not only visually unappealing, but causes pain and lack of mobility.
Two litres removed
Between 30% and 40% of breast surgery and radiotherapy patients are affected to some degree by lymphoedema.
Dr Brorson is experimenting with a variation on the standard liposuction technique, which makes approximately 20 incisions along the affected arm and uses suction to remove the fatty tissue and lymph.
However, patients must then wear an elasticated compression bandage more or less permanently to stop the lymphoedema coming back.
Dr Brorson told the European Breast Cancer Conference in Brussels that he had operated on 64 patients, removing, on average, two litres of fat from the arms of the patients..
On average, the swelling was reduced by three quarters within a fortnight, and completely within a year.
Dr Brorson told the delegates: "It can change patients' lives - I shall always remember one of my patients telling me how much it meant to her to be able to walk into a shop and for the first time in many years choose a dress, confident that it would fit her and look good on her."
Lymphoedema was described as a "Cinderella" condition by Mrs Gloria Freilich, co-chairman of the conference.
"Commonly, patients are told that nothing much can be done to help them and that they should be grateful that they have been 'cured' of cancer," she said.
"They are frequently given inappropriate advice as being told to buy a mechanical pump for the arm.
"Used without profession supervision this can actually cause immense further damage."
However, a spokesman for the Lymphoedema Support Network in the UK said that she would be surprised if liposuction could become a regular treatment for the condition, mainly because of the risks of infection.
Lymphedema caused by Liposuction
Hi, my name is Lillian Newman. My friend Denise told me about your newsletter. I want to let you know about what happened to me in hopes that it'll save other women from the same fate.
In December of 1998 I underwent bilateral ultrasonic upper arm liposuction in a local hospital, performed by a board certified plastic surgeon. I had acute hand swelling 3 days post surgery. Then mild swelling, which got worse after a ride on an airplane over the summer of 1999. I was diagnosed with lymphedema 4/19/2000. Why did it take so long?
Lymphedema is not something that a lot of doctors really know about or pay attention to, unfortunately. This I have found out the hard way. Doctors are also difficult to talk to. They don't want to talk to you because they view you as a walking lawsuit. Three have made comments on my case, two have put them in writing. The first is a vascular surgeon who confirmed the primary physician diagnosis. He stated in the letter he wrote to my primary physician that this lymphedema was a direct complication of the liposuction I had had. This was lukewarmly confirmed by a tightlipped vascular surgeon #2. Two plastic surgeons have commented on my case, but have not seen me. Both are against ultrasonic liposuction becuase of the potential of it to burn the vascular system.
Beware. They say ultrasonic liposuction is safe. If it was truly safe, I would not have stage one lymphedema. My husband and I had to purchase a Lympha Press edema pump, and I hook myself up to it nightly, after which I perform manual lymph drainage on myself. Three times a week, I am going to physical therapy where the therapist is, shooting against the odds, trying to build collateral vessels in my arms. From now on, when I board airplanes, I will have to take antibiotics and wrap both arms. A cut or a burn could land me in the hospital.
Please help me spread the word. I have a documented case of lymphedema from ultrasonic liposuction and I want people to know. I don't want others to get hurt, though I have already found three victims other than myself on the internet. One woman has stage 3 lymphedema from her liposuction 15 years ago and is so sick that lymph leaks through her skin.
Something must be done to stop the growing and DANGEROUS trend of doctors setting up shop and doing plastic surgery. People have died, people have been seriously hurt. I am one of them. I will have this cardiovascular condition for the rest of my life.
Liposuction is reserved for patients
who are healthy and without significant illnesses. Although difficult
determine absolute contraindications, the authors believe that
medical history should necessitate discussion with the patient’s
physician and/or anesthesiologist prior to approval of any procedure.
Anticoagulants (including aspirin) should be stopped 2 weeks prior to
avoid risks of hematoma and excessive bleeding. Physicians must be
attentive to herbal supplements that may affect anesthetic risks and
Obviously, patients who are unable to stop these medicines should not
considered for surgery, as in patients with cardiac valve replacement,
fibrillation, and those undergoing deep vein thrombosis and/or
Patients also must understand and discuss at length with the physician the potential risks and sequelae. The physician. Surgeons also should document all discussions with the patient regarding the potential surgery and potential risks. Port site scars also should be appreciated by the patient and occasionally can be modified to address specific needs of the patient.
For entire emedicine article on Liposuction click on the link below
THINGS TO KNOW ABOUT LIPOSUCTION
Seromas after liposuction
What causes the seromas associated with
Seromas after liposuction are the result of surgical trauma which injures or destroys the lymphatic vessels within the targeted fatty tissue. Lymphatic vessels are tiny, thin-walled tubular structures located throughout the body, and have the specific function of draining tissues of fluids that leak out of capillary blood vessels. Excessively large liposuction cannulas not only create large empty pockets within targeted fatty tissues, but also remove lymphatic vessels. Both of these conditions encourage the formation of seromas after liposuction. Unfortunately, seromas are a common problem after ultrasonic assisted liposuction (UAL). Ultrasonic liposuction cannulas create a considerable amount of heat which injures blood vessels as well as the delicate lymphatic vessels. Without lymphatic vessels to drain away excessive lymph fluid, the fluid collects within the excavated spaces in the fatty created by the liposuction process.
How can seromas be prevented?
are prevented by 1) avoiding excessive surgical
trauma to the delicate lymphatic vessels within fat, and 2) by
post-operative drainage of lymph fluid (serum) from the fatty tissues
First, the use of microcannulas can reduce the risk of seromas. Micro-cannulas are relatively small liposuction cannulas having an outside diameter less than 3 millimeters. By making relatively small tunnels within the targeted fat, micro-cannulas do not create large empty cavities within which a seroma can form as readily as larger cannulas. Large cannulas remove fat more rapidly, but more likely to cause seromas because large cannulas tend to damage lymphatic vessels, and create larger cavities within the fat.
Second, when incisions are closed with stitches, a relatively large amount of fluid is trapped under the skin where it collects and stagnates in the tunnels within the fat, thus causing a seroma. By not closing incisions with stitches (the “open-drainage” technique) and by using efficient compression garments, the drainage of blood tinged tumescent anesthetic solution and the lymphatic exudates is encouraged. Compression garments squeeze the walls of the empty tunnels together, which encourages the tunnel walls to adhere and grow together thereby obliterating the empty cavities in which seromas tend to form.
From lymph to fat: complete reduction of lymphoedema.
Department of Plastic and Reconstructive Surgery, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
lymphedema, lymphoedema, liposuction, adipose tissue, controlled compression, therapy lipectomy
Liposuction for late-stage lymphoedema remains a controversial technique. While it is clear that conservative therapies such as combined decongestive therapy (CDT) and controlled compression therapy (CCT) should be tried in the first instance, options for the treatment of late-stage lymphoedema that is not responding to treatment is not so clear. Liposuction has been used for many years to treat lipodystrophy. Some results have been far from optimal; however, improvements in technique, patient preparation and patient follow-up have led to a greater and a wider acceptance of liposuction as a treatment for lymphoedema. This paper outlines the benefits of using liposuction and presents the evidence to support its use.
Index of articles for Lymphedema Treatment :
Complex Decongestive Therapy
Flexitouch Device - Initial Observations
Flexitouch Device for Arm Lymphedema
Kinesio Taping (R)
Laser Treatment - Sara's Experience
Light Beam Generator Therapy
Lymphedema Treatment Programs Canada
Lymphedema Treatments are Poorly Utilized
Short Stretch Bandages
Why Compression Pumps cause Complications with Lymphedema
Join us as we work for lymphedema patients everywehere:
Advocates for Lymphedema
Dedicated to be an advocacy group for lymphedema patients. Working towards education, legal reform, changing insurance practices, promoting research, reaching for a cure.
Lymphedema People / Advocates for Lymphedema
For information about Lymphedema
For Information about Lymphedema Complications
For Lymphedema Personal Stories
For information about How to Treat a Lymphedema Wound
For information about Lymphedema Treatment
For information about Exercises for Lymphedema
For information on Infections Associated with Lymphedema
For information on Lymphedema in Children
Lymphedema People - Support Groups
The time has come for families, parents, caregivers to have a support group of their own. Support group for parents, families and caregivers of chilren with lymphedema. Sharing information on coping, diagnosis, treatment and prognosis. Sponsored by Lymphedema People.
No matter how you spell it, this is another very little understood and totally frustrating conditions out there. This will be a support group for those suffering with lipedema/lipodema. A place for information, sharing experiences, exploring treatment options and coping.
Come join, be a part of the family!
MEN WITH LYMPHEDEMA
If you are a man with
lymphedema; a man with a loved one with lymphedema who you are trying
and understand come join us and discover what it is to be the master
the sufferer of lymphedema.
Support group for parents, patients, children who suffer from all forms of lymphangiectasia. This condition is caused by dilation of the lymphatics. It can affect the intestinal tract, lungs and other critical body areas.
Disorders Support Group @ Yahoo Groups
While we have a number of support groups for lymphedema... there is nothing out there for other lymphatic disorders. Because we have one of the most comprehensive information sites on all lymphatic disorders, I thought perhaps, it is time that one be offered.
Information and support for rare and unusual disorders affecting the lymph system. Includes lymphangiomas, lymphatic malformations, telangiectasia, hennekam's syndrome, distichiasis, Figueroa
syndrome, ptosis syndrome, plus many more. Extensive database of information available through sister site Lymphedema People.
Lymphedema People New Wiki Pages
you seen our new
“Wiki” pages yet? Listed
are just a sample of the more than 140 pages now listed in our Wiki
are also working on hundred more.
and take a stroll!
are not for
Lymphatic Drainage (MLD) and Complex Decongestive Therapy (CDT)
to Treat a Lymphedema
para-aortic lymph node dissection (EPLND)
Needle Biopsy - Fine Needle Aspiration
Lymphedema Gene VEGFC
Lymphedema Gene SOX18
Home page: Lymphedema People
Page Updated: Jan. 11, 2012