Liposuction for Arm Lymphedema after Breast Cancer Surgery

Liposuction for Arm Lymphedema Following Breast Cancer Surgery

Fast Facts about Lymphedema and Breast Cancer Surgery

• Lymphedema is swelling of the limbs caused by abnormal build up of fluids in the body.  This may occur after breast cancer surgery, such as a mastectomy (removal of the breast) and axillary node dissection (surgery to remove the lymph nodes at the arm pit area.)
• Extensive surgery of the axilla (arm pit area) increases risk for lymphedema of the arm.
• Radiation therapy to the axilla also increases risk for arm lymphedema.
• Up to 38% of patients who undergo axillary dissection for breast cancer and radiation therapy may develop lymphedema (swelling) of the arm
• Most patients can be treated with no need for surgery.
• Patients with lymphedema are at increased risk of developing an infection of the arm, such as cellulitis.

Precautions to take to avoid an infection of the arm when one has lymphedema :

• Make every attempt to avoid cuts, scratches, hangnails, insect bites and burns.
• No blood pressures or venipunctures on the arm with the lymphedema.
• Wear protective garments when gardening or pruning, dishwashing, baking/cooking or sewing.
• Contact your physician immediately if there are any signs of infection of your arm (more swelling, redness, fever, pus drainage, more pain.)
• Carry heavy parcels or purses on the unaffected limb (no lymphedema.)
• Avoid wearing jewelry on the arm with the lymphedema.

Treatment of Severe Lymphedema of the Arm after Breast Cancer Surgery

• Dr. Brorson, a Swedish Surgeon, had shown the effectiveness of reducing lymphedema in patients who previously had breast cancer surgery by performing liposuction of the arm lymphedema. 
• According to the study, liposuction of the lymphedema arm reduced the arm edema volume by 115% versus 53% when compared with Controlled Compression Therapy (p=0.008).
• Circumferential liposuction is currently the preferred method to treat severe lymphedema that is not responsive to conservative therapy.
• There's an associated 4-fold decrease incidence of infection of the arm with the lymphedema after liposuction treatment.
• After liposuction of the arm, the patient will need to wear a compression bandage more or less permanently to prevent the lymphedema from coming back.
• Note that liposuction does not correct the inadequate lymphatic drainage found in lymphedema.
• Combined Decongestive Therapy (CDT) may be recommended initially as treatment for lymphedema after breast cancer surgery.
• CDT is a lymphedema therapy consisting of manual lymph drainage, compression bandaging, skin care, exercise and self care instruction. 

If you or your family has a history of arm lymphedema after breast cancer surgery, I recommend to ask one of your Houston Plastic Surgeons whether liposuction of the arm with lymphedema is right for you.

Emmanuel De La Cruz MD

Reference:
National Lymphedema Network.

Brorson, H. Liposuction in Arm Lymphedema Treatment. Scand J Surg. 2003;92(4):287-95.
Brorson, et al. Liposuction Reduces Arm Lymphedema Without Significantly Altering the Already Impaired Lymph Transport. Lymphology. 1998; 32:156-172 
Koul, et al. Efficacy of Complete Decongestive Therapy and Manual Lymphatic Drainage on Treatment-Related Lymphedema in Breast Cancer.  Int. Journal of Radiation Oncology Biol. Phys. 2007: 67 (3):841-846 
Williams, et al. A Randomized Controlled Crossover Study of Manual Lymphatic Drainage Therapy in WOmen with Breast Cancer-related lymphoedema. European Journal of Cancer Care. 2002. 11:254–261