Complete Reduction of Leg Lymphedema in 126 Patients with Liposuction without Recurrence - 20 Years’ Follow-up

PURPOSE: Patients with chronic non-pitting lymphedema do not respond to conservative treatment because of early deposition of excess adipose tissue caused by chronic inflammation.(1-3) Microsurgical reconstructions, in contrast to liposuction, cannot provide complete reduction. Removing the excess adipose is therefore a logical treatment strategy. This prospective study describes the long-term outcome of liposuction of leg lymphedema. METHODS: 126 patients with leg lymphedema underwent liposuction. There were 64 primary (PL), and 62 secondary lymphedemas (SL) following cancer treatment. All patients were preoperatively treated with bandaging followed by compression with flat-knitted, made-tomeasure garments to get optimal decongestion, i.e. resulting in a non-pitting lymphedema. No postoperative bandaging or manual lymphatic drainage was used. Postoperatively compression with garments continued 24/7. Volumes were measured with water plethysmography two weeks before surgery and at the same time compression garments were ordered based on measurements of the healthy leg. RESULTS: Mean SEM age at liposuction was 49 1,4 years, and duration of leg lymphedema was 13 0,9 years. Age at cancer treatment, and interval between cancer treatment and lymphedema start were 42 1,8 years and 2,8 0.7 years respectively. Age at onset of PL was 28 1,9 years. Aspirate volume was 3452 135 mL with an adipose tissue concentration of 94 0,9% in the tourniquet fraction. Preoperative excess volume was 3489 155 mL Postoperative mean reduction was 82 2,4% at 3 months and 101 2,2% at 1 year, and more than 100% during 20 years’ follow-up, i.e. a slight overcorrection. There was no difference in reduction between primary and secondary lymphedemas. No surgical complications occurred CONCLUSION: Liposuction is an effective method for treatment of chronic, non-pitting leg lymphedema with long-lasting results. Removing the hypertrophied adipose tissue is a prerequisite to achieve complete reduction. REFERENCES: 1. 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: 199-210. 2. 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: 3-10. 3. Karlsson T, Karlsson M, Ohlin K, Olsson G, Brorson H. Liposuction of Breast Cancer-Related Arm Lymphedema Reduces Fat and Muscle Hypertrophy. Lymphat Res Biol. 2022; 20: 53-63.