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Results: Aspirate mean volume was 1819 ml (range, 650-3850) with an adipose tissue concentration of 94 % (range, 58-100). Preoperative mean excess volume was 1566 ml (range, 545-3915). Postoperative mean reduction was 103 % (range, 50-194) at 3 months and more than 100% during 20 years’ follow-up, i.e. the lymphedematous arm was somewhat smaller than the healthy arm. The preoperative mean ratio between the volumes of the edematous and healthy arms was 1.5, rapidly declining to 1.0 at 3 months, and less than 1 after one year (Figure 2).
Fig. 2 - Mean pre- and post-operative excess volume reduction.
Conclusion: These long-term results demonstrate that liposuction is an effective method for treatment of chronic, non-pitting arm lymphedema in patients who have failed conservative treatment. Because of adipose tissue hypertrophy, it is the only known method that completely reduces excess volume at all stages of arm lymphedema. The removal of hypertrophied adipose tissue, induced by inflammation and slow or absent lymph flow is a prerequisite to complete reduction. The newly reduced volume is maintained through constant (24-hour) use of compression garments postoperatively.
Complete reduction of lymphedema induced adipose tissue hypertrophy in elephantiasis of the leg – a prospective study with a ten-year follow-up
Introduction: Patients with long-standing pronounced non-pitting lymphedema do not respond to conservative treatment or microsurgical procedures because slow or absent lymph flow, as well as chronic inflammation, cause the formation of excess subcutaneous adipose tissue, which cannot be removed by these methods. The swelling of chronic non-pitting arm lymphedema following breast cancer, can be completely reduced by liposuction and has not recurred during more than nineteen years’ follow-up. Encouraged by this experience, we decided to test the effectiveness of liposuction on leg lymphedema.
Materials and Methods: 56 patients with an age of 52 years (range, 17-76) and a duration of leg swelling of 14 years (range, 2-50) underwent liposuction due to non-pitting, chronic lymphedema. There were 29 primary (PL), and 27 secondary lymphedemas (SL) following cancer therapy. Age at cancer treatment and interval
between cancer treatment and lymphedema start were 43 years
(range, 20-65), and 3 years (range, 0-26) respectively. Age at onset of PL was 32 years (range, 4-63). All patients had received conservative treatment before surgery without further reduction. All were wearing compression garments before surgery. Aspirate and leg volumes were recorded.
Results: Aspirate volume was 3872 ml (range, 1210-8475) with an adipose tissue concentration of 94% (range, 61-100). Preoperative excess volume was 3935 ml (range, 1200-8475). Postoperative mean reduction was 83% (range, 22-135) at 3 months and 104% (range, 75-163) at 1 year, and more than 100% during 10 years’ folow-up when it was 115% (range, 112-119), i.e. the lymphedematous leg was somewhat smaller than the healthy one (Figure 1 and 2).
Fig. 1 - A 32-years-old woman with a non-pitting secondary leg lymphedema of 7 070 ml since 12 years following treatment of a synovial sarcoma in the right groin (left). Postoperative results 6 months after liposuction (right).
(to be continued)
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THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015