Schaverien, M.V., Munro, K.J., Baker, P.A., & Munnoch, D.A. (2012). Liposuction for chronic lymphoedema of the upper limb- 5 years of experience. Journal of Plastic, Reconstructive & Aesthetic Surgery, 65, 935–942.

To describe the five-year follow-up results of the use of liposuction for arm lymphedema after breast cancer treatment

Patients who had chronic arm lymphedema who were compliant with use of compression garments were referred for liposuction surgery. Study questionnaires and limb volume measures were performed pre- and postoperatively. Limb volume was measured at 2 and 4 weeks postoperatively and at 3 months, 6 months, and yearly for 5 years. Specific liposuction technique was described. Patients had a custom-made pressure garment applied at the time of the surgery.  All received 5-day courses of antibiotics, analgesia, and limb elevation. Patients were discharged on day 4.

• The study reported on 12 patients who were followed for one year. Only two patients were available for follow up in the fifth year.
• The mean age of patients was 48 years with a range of 38–60 years.
• The sample was 100% female.
• All of the patients had breast cancer. Lymphedema developed at an average of one year after initial surgery, and mean duration was 7 years.
• Eleven of the patients received axillary dissection, while one developed lymphedema after subsequent thyroidectomy. 
• Most of the patients had received adjuvant radiation or chemotherapy.

The study was conducted at a single site, inpatient and outpatient setting, in the United Kingdom.

• Patients were undergoing long-term, follow-up care.
• The study has clinical applicability for late effects and survivorship.

This study involved prospective analysis.

• The Hospital Anxiety and Depression Scale (HADS) was used.
• A visual analog scale (VAS) was used to measure overall well being.
• Arm volume was measured using conal measurement at 4-cm intervals.

No surgical complications occurred. The mean percent reduction in arm volume after surgery was 84%. At one year after surgery, the mean volume difference between operated and unaffected arms was 29 ml. At two years, a mean volume ratio of the operated to nonoperated arm of 0.98 was found, demonstrating that volumes were virtually the same.  In 11 patients, postoperative anxiety scores declined (p = 0.049). Researchers noted that ongoing compliance with use of compression garments was essential to continued effect.

Findings suggest that liposuction and ongoing use of compression garments may be a promising approach to manage upper extremity lymphedema in patients after surgery for breast cancer.

• The sample size was small with fewer than 30 participants.
• No comparison or control group was included; however, these results are shown in patients who had prior unsuccessful standard treatments for lymphedma.

Further research into this intervention is needed to further validate these findings in comparison with other approaches.  Liposuction may have some benefit for patients with lymphedema that is not adequately controlled by other means.  The procedure for this application is very specific and requires specific surgical training in this technique.