Complete Reduction of Arm Lymphedema Following Breast Cancer – a Prospective Twenty-One Years' Study

BACKGROUND

Patients with chronic non-pitting lymphedema do not respond to conservative treatment because diminished lymph flow and inflammation result in the formation of excess subcutaneous adipose tissue.¹ Previous surgical treatments utilizing either total excision with skin grafting or reduction plasty seldom achieved acceptable cosmetic and functional results. Microsurgical reconstructions, although attractive as a physiological concept, cannot provide complete reduction in chronic non-pitting lymphedema because they do not eliminate the newly formed subcutaneous adipose tissue collections. To remove the excess adipose seems thus to be a logical treatment strategy.² This prospective study describes the long-term outcome of liposuction of lymphedema.

METHODS

146 women with non-pitting edema, a mean age of 63 (range, 39-89) years and a mean duration of arm swelling of 9 (range, 1-38) years underwent liposuction. Mean age at breast cancer operation, mean interval between breast cancer operation and lymphedema start, and duration of lymphedema were 52 years (range, 31-86), 3 years (range, 0-32), and 9 years (range, 1-38) respectively. Aspirate and arm volumes were recorded.

RESULTS

Aspirate mean volume was 1807 ml (range, 650-3850) with an adipose tissue concentration of 95 % (range, 58-100). Preoperative mean excess volume was 1568 ml (range, 545-4235). Postoperative mean reduction was 103 % (range, 50-194) at 3 months and more than 100% during 21 years' follow-up, i.e. the lymphedematous arm was somewhat smaller than the healthy arm. The preoperative mean ratio between the volumes of the edematous and healthy arms was 1.5, rapidly declining to 1.0 at 3 months, and less than 1 after one year.

CONCLUSION

Liposuction is an effective method for treatment of chronic, non-pitting arm lymphedema in patients who have failed conservative treatment. Because of adipose tissue hypertrophy, it is the only known method that completely reduces excess volume at all stages of arm lymphedema. Removing the hypertrophied adipose tissue is a prerequisite to complete reduction (Figure 1 and 2). The newly reduced volume is maintained through constant use of compression garments.

LEGENDS

Figure 1.   A 57-years-old woman with a non-pitting secondary lymphedema of 4 235 ml since 5 years following breast cancer treatment.

Figure 2.   Complete reduction 6 months after liposuction.