Swedish Physician Uses Liposuction to Help Treat Lymphedema (dateline April 20, 2001)
Liposuction is usually performed for cosmetic reasons to remove unwanted fat from certain areas of the body, such as the stomach or thighs. However, Swedish physician Hakan Brorson, MD, PhD has been using liposuction on breast cancer patients who experience severe, chronic lymphedema of the arm. Lymphedema is persistent arm swelling that occurs in approximately 15% to 20% of breast cancer patients who have had axillary (underarm) lymph nodes removed as part of their treatment. Current lymphedema treatments include manual lymph drainage with massage and medical compression bandaging, although many patients must still cope with the effects of lymphedema on a daily basis. To date, Dr. Brorson has successfully used liposuction to treat 72 lymphedema patients in Sweden, although long term follow-up is still needed.
Most breast cancer patients who undergo surgery and lymph node removal as part of their treatment experience some swelling (edema) in the affected breast and arm area during the first six to 12 weeks after surgery. Light arm and hand exercises are usually recommended during breast cancer treatment and up to 18 months after treatment has been completed to help keep the arm mobile. However, for reasons that are not fully understood, some patients go on to develop chronic arm swelling (lymphedema) that can cause physical and emotional hardship.
Dr. Brorson, head of the Lymphedema Unit in the Department of Plastic and Reconstructive Surgery at Malmo University Hospital in Malmo, Sweden, has been investigating how liposuction can help alleviate the chronic arm pain and swelling associated with lymphedema. Lymphedema is believed to be caused by an accumulation of lymphatic fluid in the arm. This accumulation occurs because surgery to remove the lymph nodes impairs lymph drainage (this drainage can also be further impaired by the use of radiation therapy in addition to lymph node removal). However, according to Dr. Brorson, lymphedema can also be worsened by the accumulation of fatty (adipose) tissue in the arm. Dr. Brorson believes liposuction can successfully remove this excess tissue, thereby reducing the symptoms of lymphedema.
To perform liposuction on his lymphedema patients, Dr. Brorson removes excess fatty tissue by making 15 to 20 small incisions (approximately 3 millimeters each) in the arm. The procedure is only performed on patients with severe lymphedema who do not show any signs of skin pitting (and therefore may not respond well to standard lymphedema treatments such as massage or the use of compression bandages). Pitting means that depressions in the arm skin can be seen by applying pressure to the arm with the fingers. According to Dr. Brorson, the tissue removed during liposuction in these patients is 80% to 100% fat, so it does not further worsen the transportation of lymph in the arm.
After the liposuction surgery is performed, Dr. Brorson believes it is very important to continue therapy with controlled compression bandages. A custom-made compression garment is made for each of his patients after surgery, taking into account the reduction in arm volume. After one month, the arm is measured again, and another compression garment is made to be used in alternation with the old garment for three months. At the three-month, six-month, and 12-month marks, additional compression garments are made based on new arm measurements. This contrasts to how lymphedema patients are normally treated, where they only receive one compression garment. Dr. Brorson believes that renewing measurements for compression garments three of four times during the first year can help sustain a reduction in arm volume.
Using liposuction to treat severe lymphedema with no signs of arm pitting is an accepted treatment in the European Community. The Swedish National Board of Health has also approved the technique. Dr. Brorson has published several reports of his technique in medical journals and believes that liposuction will soon be used more commonly in the United States to treat lymphedema. However, he cautions that the procedure must be performed by a highly skilled surgeon who has been taught by Dr. Brorsons surgical team. Liposuction has been successful in completing reducing arm swelling in 72 patients in Sweden, but the patients need to be followed for seven years to ensure that the treatment is lasting.
All patients who have lymph nodes removed should be taught how to take care of the affected arm and help prevent lymphedema. Patients should also know the early signs of lymphedema and report any symptoms to their physicians immediately to help avoid long-term suffering.
Breast cancer patients can help reduce their chances of developing lymphedema by practicing light arm exercises after their surgery. Patients should discuss when and how to perform these exercises when their surgeon. Click here to read about sample arm exercises that can be used to help prevent or manage lymphedema.
Current lymphedema treatment often involves combining a number of therapies, called complex decongestive therapy (CDT). CDT includes manual lymph drainage (MLD). In this procedure, an MLD certified therapist gently massages arm tissues to stimulate the movement of lymph to healthy lymphatic vessels. In addition, medical compression bandaging, lymphedema exercises while wearing a bandage, patient education (suggestions to reduce and cope with lymphedema), and using compression garments after swelling has been reduced are essential components of decongestive therapy.