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, 6 (8), e1912
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Liposuction Gives Complete Reduction of Arm Lymphedema Following Breast Cancer Treatment-A 5-year Prospective Study in 105 Patients Without Recurrence

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Liposuction Gives Complete Reduction of Arm Lymphedema Following Breast Cancer Treatment-A 5-year Prospective Study in 105 Patients Without Recurrence

Mattias Hoffner et al. Plast Reconstr Surg Glob Open.

Abstract

Background: Arm lymphedema is a well-recognized complication after breast cancer surgery that negatively impacts patients' quality of life, both physiologically and psychologically. Lymph stasis and inflammation result in excess formation of adipose tissue, which makes removal of the deposited subcutaneous fat necessary to eliminate the excess volume. Liposuction, combined with postoperative controlled compression therapy (CCT), is the only treatment that gives complete reduction of the excess volume. The aim of this study was to evaluate the 5-year results after liposuction in combination with CCT.

Methods: Patients consecutively operated on between 1993 and 2012 were identified from the lymphedema registry, comprising all patients with nonpitting lymphedema treated with liposuction and CCT in our department. Standardized forms were used to collect pre-, peri-, and postoperative data.

Results: One hundred five women with nonpitting edema were treated. The mean interval between the breast cancer operation and lymphedema start was 2.9 ± 5.0 years, the mean duration of lymphedema was 10 ± 7.4 years, and the preoperative mean excess volume was 1,573 ± 645 ml. The mean volume aspirated was 1,831 ± 599 ml. Postoperative mean reduction 5 years postoperatively was 117% ± 26% as compared with the healthy arm.

Conclusion: Liposuction is an effective method for the treatment of chronic, nonpitting, arm lymphedema resistant to conservative treatment. The volume reduction remains complete after 5 years.

Figures

Fig. 1.
Fig. 1.
Liposuction of arm lymphedema combined with the use of tourniquet and tumescence technique. The procedure takes about 2 hours. From preoperative to postoperative state (left to right). (Published with permission from J Lymphoedema 2008; 1: 38–47).
Fig. 2.
Fig. 2.
The compression garment and interim glove at the end of surgery.
Fig. 3.
Fig. 3.
Interim glove with gauntlet.
Fig. 4.
Fig. 4.
Compression garment secured with a strap.
Fig. 5.
Fig. 5.
Aspirate analysis in 76 patients when tourniquet was used. Mean peroperative aspirate (fat and fluid fractions) and excess volumes. The excess volume was 1,525 ± 645 ml (range, 570–3,520). Tourniquet: Fractions removed while using the tourniquet. Tumescence: Fractions removed from the area where the tourniquet was applied. Whole arm: Fractions of the total aspirate. Whole arm excluding tumescence fluid: The volume of all fat + fluid fraction when using tourniquet. Preoperative excess volume: Volume of swollen arm minus volume of normal arm. The mean volume of aspirate removed when a tourniquet was applied (n = 76) was 951 ± 405 ml (range, 310–2,060) and contained 94 ± 11% fat (range, 58–100). The mean volume of aspirate removed with tumescence* was 795 ± 275 ml (range, 210–1,700), and the mean proportion of fat was 72 ± 12% (range, 42–100). The high proportion of fluid in the tumescence fraction was due to the aspirated tumescent fluid. Thus, excluding the fluid in the tumescence fraction gives an aspirate fat content of 96 ± 7.0% (range, 74–100). *One patient has no swelling in the proximal part of the upper arm, thus no liposuction was made here resulting in 0 aspirate and was excluded in the analysis of the tumescent fraction.
Fig. 6.
Fig. 6.
Pre- and postoperative excess volume reduction (mean ± SD). Following surgery a significant reduction was seen at 2 weeks and continued during the follow-up with a complete reduction at 6 months that was maintained during 5 years’ follow-up.
Fig. 7.
Fig. 7.
Pre- and postoperative excess ratio (affected/nonaffected arm) reduction (mean ± SD). After 6 months, the ratio was less than 1.
Fig. 8.
Fig. 8.
A, A 57-year-old woman with an excess volume of 4,325 ml that had existed for 5 years. B, Complete reduction at 1 year after liposuction.
Fig. 9.
Fig. 9.
A, A 77-year-old woman with an excess volume of 2,480 ml that had lasted for 9 years. B, Complete reduction at 5 years after liposuction.
Fig. 10.
Fig. 10.
Percentage reduction of the excess volume at 5 years compared with the preoperative excess volume.
Fig. 11.
Fig. 11.
The cumulative sum control chart of the operation serial number with expected 90% success at 5 years with a 95% confidence interval. Thus, 9 out of 105 patients (8.6%) did not get 90% reduction.

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