Boyages J, Kastanias K, Koelmeyer LA, Winch CJ, Lam TC, Sherman KA, Munnoch DA, Brorson H, Ngo QD, Heydon-White A, Magnussen JS, Mackie H, et al.
Annals of surgical oncology. Date of publication 2015 Dec 1;volume 22 Suppl 3():S1263-70.
1. Ann Surg Oncol. 2015 Dec;22 Suppl 3:S1263-70. doi: 10.1245/s10434-015-4700-3.
Epub 2015 Jun 30.
Liposuction for Advanced Lymphedema: A Multidisciplinary Approach for Complete
Reduction of Arm and Leg Swelling.
Boyages J(1)(2), Kastanias K(3), Koelmeyer LA(3), Winch CJ(3), Lam TC(3), Sherman
KA(4), Munnoch DA(3)(5), Brorson H(6), Ngo QD(3), Heydon-White A(7), Magnussen
JS(8), Mackie H(3)(9).
Author information:
(1)Department of Clinical Medicine, Faculty of Medicine and Health Sciences, 2
Technology Place, Macquarie University, Sydney, NSW, Australia.
john.boyages@mq.edu.au.
(2)Genesis Cancer Care, Macquarie University Hospital, 3 Technology Place,
Macquarie University, Sydney, NSW, Australia. john.boyages@mq.edu.au.
(3)Department of Clinical Medicine, Faculty of Medicine and Health Sciences, 2
Technology Place, Macquarie University, Sydney, NSW, Australia.
(4)Centre for Emotional Health, Department of Psychology, Macquarie University,
Sydney, NSW, Australia.
(5)Department of Plastic Surgery, Ninewells Hospital, Dundee, UK.
(6)Plastic and Reconstructive Surgery, Department of Clinical Sciences, Skåne
University Hospital, Lund University, Malmö, Sweden.
(7)The Clinic Physiotherapy, Macquarie University Hospital, 2 Technology Place,
Macquarie University, Sydney, NSW, Australia.
(8)Macquarie Medical Imaging, Macquarie University Hospital, 3 Technology Place,
Macquarie University, Sydney, NSW, Australia.
(9)Mt. Wilga Rehabilitation Hospital, Hornsby, NSW, Australia.
PURPOSE: This research describes and evaluates a liposuction surgery and
multidisciplinary rehabilitation approach for advanced lymphedema of the upper
and lower extremities.
METHODS: A prospective clinical study was conducted at an Advanced Lymphedema
Assessment Clinic (ALAC) comprised of specialists in plastic surgery,
rehabilitation, imaging, oncology, and allied health, at Macquarie University,
Australia. Between May 2012 and 31 May 2014, a total of 104 patients attended the
ALAC. Eligibility criteria for liposuction included (i) unilateral, non-pitting,
International Society of Lymphology stage II/III lymphedema; (ii) limb volume
difference greater than 25 %; and (iii) previously ineffective conservative
therapies. Of 55 eligible patients, 21 underwent liposuction (15 arm, 6 leg) and
had at least 3 months postsurgical follow-up (85.7 % cancer-related lymphedema).
Liposuction was performed under general anesthesia using a published technique,
and compression garments were applied intraoperatively and advised to be worn
continuously thereafter. Limb volume differences, bioimpedance spectroscopy
(L-Dex), and symptom and functional measurements (using the Patient-Specific
Functional Scale) were taken presurgery and 4 weeks postsurgery, and then at 3,
6, 9, and 12 months postsurgery.
RESULTS: Mean presurgical limb volume difference was 45.1 % (arm 44.2 %; leg 47.3
%). This difference reduced to 3.8 % (arm 3.6 %; leg 4.3 %) by 6 months
postsurgery, a mean percentage volume reduction of 89.6 % (arm 90.2 %; leg 88.2
%) [p < 0.001]. All patients had improved symptoms and function. Bioimpedance
spectroscopy showed reduced but ongoing extracellular fluid, consistent with the
underlying lymphatic pathology.
CONCLUSIONS: Liposuction is a safe and effective option for carefully selected
patients with advanced lymphedema. Assessment, treatment, and follow-up by a
multidisciplinary team is essential.
DOI: 10.1245/s10434-015-4700-3
PMCID: PMC4686553
PMID: 26122375 [Indexed for MEDLINE]
