What is Lymphedema?
This is swelling of a body part due to the blockage or absence of lymphatic channels. Fluid is released from the blood vessels that circulate blood around the body and this extra fluid in the tissues is carried away by lymphatic channels. When these do not work the affected area of the body becomes progressively swollen. At first this swelling is all additional fluid with swollen tissues that have ‘pitting’, where if you press into the skin it will leave an indentation.
Over time the swelling will become scarred and firmer and often replaced by fat. At this stage the affected area will not so obviously ‘pit’ although it is also common for there to be a mixture of fat/scarring and additional fluid.
Lymphedema is described as Primary Lymphedema (congenital absence of lymphatics) resulting in lymphedema developing in early life and most common in lower legs or Secondary Lymphedema (following injury or removal lymphatics, most commonly from surgery, infection or radiotherapy).
Removal of lymph nodes as part of cancer treatment is the most common cause of secondary lymphedema. This would see arm swelling after some cancer treatments or leg swelling following some gynaecological cancer surgery.
The problems with lymphedema are both physical and cosmetic. The physical problems include heaviness to the limb, difficulty with using the limb, problems with clothes and footwear, infections and skin changes.
This is divided into three main areas of compression therapy with drainage excercises, liposuction of additional fat to reduce the weight and size and finally physiological operations to reconstruct the lymphatics. As of 2019 only the first two options are offered by Stephen McCulley but if physiological options are felt to be better you will be referred on.
Compression therapy and manual drainage exercises can be highly effective and needs to be managed by expert physiotherapists within a lymphedema service. Many patients can manage their lymphedema very well once taught these techniques and with suitable garments.
Liposuction treatment is very effective for managing progressive fat deposition which can result in a very large and heavy leg. The additional fat is removed using liposuction techniques followed by compression garments. This is used on both the arm and legs. It always improves the swelling but this can vary from 30% up to 100% improvements. Usually a 70-80% improvement is expected. Patients still have to wear compression garments after surgery and need to get rid of fluid swelling with compression first.
The physiological operations aim to create new lymphatic circulation but either connecting remaining lymphatic channels to small veins (LVA – Lymphatic Venous Anastomosis) or by transferring new lymph nodes from a healthy area into the affected area with use of microsurgery.
These techniques can work well and even remove the need for compression garments and hence a true cure. However, outcomes are variable with often quite complex surgery. These techniques will not help an arm or leg that already has a lot of fat deposition. This may need to be managed in addition with liposuction.
Complications of liposuction for lymphedema
- Bleeding – Very uncommon as performed under tourniquet. However there is a small risk of some bleeding after surgery. Usually managed by compression.
- Infection – Would be treated with antibiotics
- Scarring – The scars from liposuction are small heal very well in most patients. Occasionally they can become pink and thickened in some and there is a small risk of long-term hypertrophic or keloid scarring.
- Altered sensation to skin. Usually short term
- Seroma – This is a fluid collection under the skin that may require needle aspiration or a drain.
- Skin loss – Very uncommon but is a small risk due to the extensive liposuction performed.
- Nerve injury– Rare but some sensory and occasionally nerves supplying muscles can be injured on a temporary or permanent basis.
- Insufficient change – It can be repeated but in some patients the excessive swelling is also scarring, bone and muscle growth so limiting the change.
- General complications such as chest infection, Deep Vein Thrombosis or pulmonary embolus (blood clots leg and lung)
The costs will vary depending upon whether the garments are supplied via the NHS lymphedema clinic. Costs for the liposuction is from £6,250