Lymphedema pp 409-416 | Cite as

Surgical Treatment of Postmastectomy Lymphedema – Liposuction

  • Håkan Brorson


There are various possible explanations for adipose tissue hypertrophy in lymphedema. There is a physiological imbalance of blood flow and lymphatic drainage, resulting in the impaired clearance of lipids and their uptake by macrophages.1,2 There is increasing support, however, for the view that the fat cell is an endocrine organ and a cytokine-activated cell,3,4 and chronic inflammation plays a role here.5,6


Adipose Tissue Excess Volume Conservative Regimen Compression Garment Excess Adipose Tissue 
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  1. 1.
    Vague J, Fenasse R. Comparative anatomy of adipose tissue. In: Renold AE, Cahill GF, eds. American Handbook of Physiology, Section 5. Washington DC: American Physiology Society; 1965:25-36.Google Scholar
  2. 2.
    Ryan TJ. Lymphatics and adipose tissue. Clin Dermatol. 1995;13:493-498.PubMedCrossRefGoogle Scholar
  3. 3.
    Mattacks CA, Sadler D, Pond CM. The control of lipolysis in perinodal and other adipocytes by lymph node and adipose tissue derived dendritic cells in rats. Adipocytes. 2005;1:43-56.Google Scholar
  4. 4.
    Pond CM. Adipose tissue and the immune system. Prostaglandins Leukot Essent Fatty Acids. 2005;73:17-30.PubMedCrossRefGoogle Scholar
  5. 5.
    Borley NR, Mortensen NJ, Jewell DP, Warren BF. The relationship between inflammatory and serosal connective tissue changes in ileal Crohn’s disease: evidence for a possible causative link. J Pathol. 2000;190:196-202.PubMedCrossRefGoogle Scholar
  6. 6.
    Sadler D, Mattacks CA, Pond CM. Changes in adipocytes and dendritic cells in lymph node containing adipose depots during and after many weeks of mild inflammation. J Anat. 2005;207:769-781.PubMedCrossRefGoogle Scholar
  7. 7.
    Harvey NL, Srinivasan RS, Dillard ME, et al. Lymphatic vascular defects promoted by Prox1 haploinsufficiency cause adult-onset obesity. Nat Genet. 2005;37:1072-1081.PubMedCrossRefGoogle Scholar
  8. 8.
    Schneider M, Conway EM, Carmeliet P. Lymph makes you fat. Nat Genet. 2005;37:1023-1024.PubMedCrossRefGoogle Scholar
  9. 9.
    Jones B, Fishman EK, Hamilton SR, et al. Submucosal accumulation of fat in inflammatory bowel disease: CT/pathologic correlation. J Comput Assist Tomogr. 1986;10:759-763.PubMedCrossRefGoogle Scholar
  10. 10.
    Sheehan AL, Warren BF, Gear MW, Shepherd NA. Fat-wrapping in Crohn’s disease: pathological basis and relevance to surgical practice. Br J Surg. 1992;79:955-958.PubMedCrossRefGoogle Scholar
  11. 11.
    Brorson H, Åberg M, Svensson H. Chronic lymphedema and adipocyte proliferation: clinical therapeutic implications. Lymphology. 2004;37(Suppl):153-155.Google Scholar
  12. 12.
    Lantz M, Vondrichova T, Parikh H, et al. Overexpression of immediate early genes in active Graves’ ophthalmopathy. J Clin Endocrinol Metab. 2005;90:4784-4791.PubMedCrossRefGoogle Scholar
  13. 13.
    Bagheri S, Ohlin K, Olsson G, Brorson H. Tissue tonometry before and after liposuction of arm lymphedema following breast cancer. Lymphat Res Biol. 2005;3:66-80.PubMedCrossRefGoogle Scholar
  14. 14.
    Brorson H, Ohlin K, Olsson G, Nilsson M. Adipose tissue dominates chronic arm lymphedema following breast cancer: an analysis using volume rendered CT images. Lymphat Res Biol. 2006;4:199-210.PubMedCrossRefGoogle Scholar
  15. 15.
    Brorson H. Adipose tissue in lymphedema: the ignorance of adipose tissue in lymphedema. Lymphology. 2004;37:135-137.Google Scholar
  16. 16.
    Brorson H, Ohlin K, Olsson G, Karlsson MK. Breast cancer-related chronic arm lymphedema is associated with excess adipose and muscle tissue. Lymphat Res Biol. 2009;7:3-10.PubMedCrossRefGoogle Scholar
  17. 17.
    Brorson H, Svensson H. Liposuction combined with controlled compression therapy reduces arm lymphedema more effectively than controlled compression therapy alone. Plast Reconstr Surg. 1998;102:1058-1067. discussion 1068.PubMedCrossRefGoogle Scholar
  18. 18.
    Baumeister RG, Siuda S. Treatment of lymphedemas by microsurgical lymphatic grafting: what is proved? Plast Reconstr Surg. 1990;85:64-74. discussion 75-76.PubMedCrossRefGoogle Scholar
  19. 19.
    Baumeister RG, Frick A. The microsurgical lymph vessel transplantation. Handchir Mikrochir Plast Chir. 2003;35:202-209.PubMedCrossRefGoogle Scholar
  20. 20.
    Campisi C, Davini D, Bellini C, et al. Lymphatic microsurgery for the treatment of lymphedema. Microsurgery. 2006;26:65-69.PubMedCrossRefGoogle Scholar
  21. 21.
    Brorson H, Svensson H, Norrgren K, Thorsson O. Liposuction reduces arm lymphedema without significantly altering the already impaired lymph transport. Lymphology. 1998;31:156-172.PubMedGoogle Scholar
  22. 22.
    Brorson H, Svensson H. Complete reduction of lymphoedema of the arm by liposuction after breast cancer. Scand J Plast Reconstr Surg Hand Surg. 1997;31:137-143.PubMedCrossRefGoogle Scholar
  23. 23.
    Brorson H. Liposuction in arm lymphedema treatment. Scand J Surg. 2003;92:287-295.PubMedGoogle Scholar
  24. 24.
    Brorson H, Ohlin K, Olsson G, Svensson B. Liposuction of postmastectomy arm lymphedema completely removes excess volume: a thirteen year study (Quad erat demonstrandum). Eur J Lymphol. 2007;17:9.Google Scholar
  25. 25.
    Brorson H, Freccero C, Ohlin K, Svensson B. Liposuction normalizes elephantiasis of the leg. A prospective study with a 6 years follow up. Eur J Lymphol. 2009;20:29.Google Scholar
  26. 26.
    Brorson H, Ohlin K, Svensson B, Svensson H. Controlled compression therapy and liposuction treatment for lower extremity lymphedema. Lymphology. 2008;41:52-63.PubMedGoogle Scholar
  27. 27.
    Clayton DN, Clayton JN, Lindley TS, Clayton JL. Large volume lipoplasty. Clin Plast Surg. 1989;16:305-312.PubMedGoogle Scholar
  28. 28.
    Klein JA. The tumescent technique for liposuction surgery. Am J Cosm Surg. 1987;4:263-267.Google Scholar
  29. 29.
    Wojnikow S, Malm J, Brorson H. Use of a tourniquet with and without adrenaline reduces blood loss during liposuction for lymphoedema of the arm. Scand J Plast Reconstr Surg Hand Surg. 2007;41:243-249.PubMedCrossRefGoogle Scholar
  30. 30.
    Brorson H, Ohlin K, Olsson G, Långström G, Wiklund I, Svensson H. Quality of life following liposuction and conservative treatment of arm lymphedema. Lymphology. 2006;39:8-25.PubMedGoogle Scholar
  31. 31.
    Brorson H, Svensson H. Skin blood flow of the lymphedematous arm before and after liposuction. Lymphology. 1997;30:165-172.PubMedGoogle Scholar
  32. 32.
    Damstra RJ, Voesten HG, Klinkert P, Brorson H. Circumferential suction-assisted lipectomy for lymphedema after surgery for breast cancer. Br J Surg. 2009;96:859-864.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2011

Authors and Affiliations

  1. 1.Department of Clinical Sciences in MalmöLund UniversityMalmöSweden
  2. 2.Plastic and Reconstructive SurgerySkåne University HospitalMalmöSweden

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