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PURPOSE:
Breast cancer is the most common disease in women, and up to 38% develop lymphedema of the arm following mastectomy, standard axillary node dissection and postoperative irradiation. Limb reductions have been reported utilizing various conservative therapies such as manual lymph and compression therapies. Patients with longstanding, pronounced, non-pitting lymphedema do not respond to conservative treatment because diminished lymph flow and inflammation result in the formation of excess subcutaneous adipose tissue. Previous surgical treatments utilizing either total excision with skin grafting or reduction seldom achieved acceptable cosmetic and functional results. Microsurgical reconstruction involving lymphovenous shunts or transplantation of lymph vessels cannot provide complete reduction in chronic non-pitting lymphedema because it does not eliminate newly formed subcutaneous adipose tissue collections.
METHODS:
104 women with non-pitting edema, a mean age of 64 years (39-89) and a mean duration of arm swelling of 9 years (1-38) underwent liposuction. Age at breast cancer operation and interval between breast cancer operation and lymphedema start were 52 years (33-86), and 3 years (0-32) respectively. The total volume of aspirate was measured. Pre- and postoperative arm volumes were recorded. The decrease in the edema volume was also calculated both as a percentage of the preoperative edema volume, as well as a ratio between the volumes of the edematous and healthy arms (Fig. 1a, b).
RESULTS:
Aspirate mean volume was 1926 ml (780-3850). Preoperative edema volume was 1698 ml (570-3195). Postoperative reduction values were 100% at 3 months and more than 100% during follow-up to 15 years. (n=105), 105 % at 6 months (n=101), 111% at 1 year (n=98), 114% at 2 years (n=90), 111 % at 3 years (n=84), 112% at 4 years (n=77), 112% at 5 years (n=71), 112% at 6 years (n=66), 115% at 7 years (n=59), 113% at 8 years (n=55), 113% at 9 years (n=42), 115% at 10 years (n=30), 116% at 11 years (n=24), 120% at 12 years (n=19), 118% at 13 years (n=14), 128% at 14 years (n=11), and 117% (n=6) at 15 years, i.e. the lymphedematous arm was somewhat smaller than the healthy arm. The preoperative ratio between the volumes of the edematous and healthy arms was 1.52, rapidly declining to 1,0 at 3 months, and less than 1 after 1 year (Fig. 2).
CONCLUSION:
These long-term results demonstrate that liposuctioning 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. The removal of hypertrophied adipose tissue, induced by inflammation and slow or absent lymph flow is a prerequisite to complete reduction. The newly reduced volume is maintained through constant (24-hour) use of compression garments postoperatively.