Liposuction for Lymphoedema

What is liposuction for lymphoedema?

Liposuction is a surgical procedure for removing fat.

Patients with lymphoedema have impaired lymphatic drainage and proteins and lipids accumulate in the interstitial space, causing the regional tissue to undergo extensive and progressive architectural changes, including adipose tissue deposition and fibrosis.

In patients with longstanding lymphoedema, the increased fat deposition in the limb is resistant to compression garments and manual lymphatic drainage. Thus, even if the excess fluid resolves, the limb affected by lymphoedema will still be larger than the opposite limb. Liposuction can remove these fatty deposits permanently.

When performed alone, liposuction will result in an immediate reduction in the size of the limb.

However, it is essential that patients continue to wear compression garments, as the limb will swell again if compression is not maintained.

For patients who have had a lymph node transfer, then liposuction is an adjunctive procedure to achieve a final contour. It is possible that compression garments will not be required if the lymph nodes are fully functioning and have resolved the lymphoedema.

The assessment of a physiotherapist, with experience in lymphoedema, is essential to the process.

Suction-assisted liposuction is performed under general anaesthetic (when patients are full unconscious) as a day case or one night stay, dependent upon the quantity of fat removed.

Liposuction involves the use of a cannula (a thin, hollow tube) to manually loosen and remove fat to reduce the excess fat deposition so that the affected limb is the same size and shape as the contra-lateral one.

The cannula is inserted through tiny incisions (4mm) in the skin and suction is applied to remove fat from the body. It takes between 1 to 3 hours to perform the surgery, depending on the size of the treatment area. The incisions are closed with a small dissolvable stitch and covered by a waterproof dressing.

It is common to leak a significant amount of blood-stained fluid from the incisions over the first 24 hours. This is normal and nothing to worry about. To perform liposuction, I inject several litres of fluid with adrenaline and tranexamic acid to stop bleeding, as well as local anaesthetic into the areas. Most of this is removed by the liposuction but some excess fluid is to be expected, which leaks out from the incisions. It can appear to be a lot of blood, but in fact it is mainly fluid with a small amount of blood in it.

Patients must then wear compression garments to help shape the area and reduce the swelling. The garments will be measured before surgery, based on the size of the patient’s normal contralateral limb. It is put on the patients whilst they are in theatre and will wake up with the compression on.

Having surgery should be a very positive experience. Complications are infrequent and usually minor. However, all surgery has risk, and it is important that you are aware of possible complications. All the risks will be discussed in detail at your consultation. However, if you have further questions or concerns, do not hesitate to discuss them. Decisions about cosmetic surgery should never be rushed.

These risks can be divided into the risks specific from surgery and the risks of anaesthesia.

General Anaesthetic risks: An anaesthetic is very safe, however, should a complication arise, the relevant medical expertise is immediately available to deal with this.

The risks increase if you have certain medical problems, which will be discussed at length during the consultation. The risks include:

  • Unintended intraoperative awareness, which is very rare
  • Dizziness and nausea
  • Sore throat
  • Damage to teeth or mouth
  • Nerve injury due to body positioning
  • Allergic reaction or anaphylaxis
  • Malignant hyperthermia, which is a rare life-threatening condition

The anaesthetist will go through these risks in more detail prior to your surgery.

Scars: The scars are very small (less then 5mm) and they should be barely perceptible. However, some people heal with thickened scars, which makes them more noticeable.

Leakage of blood/fluid: It is common to leak a significant amount of blood-stained fluid from the incisions over the first 24 hours. This is normal and nothing to worry about. To perform liposuction, I inject several litres of fluid with adrenaline and tranexamic acid to stop bleeding, as well as local anaesthetic into the areas. Most of this is removed by the liposuction but there will be some excess fluid, which leaks out from the incisions. It can look like a lot of blood, but this is normal and is mainly fluid with a small amount of blood in it.

Blood loss: Patients with lymphoedema have leaky blood vessels, varicose veins and sometimes anaemia before surgery. They are more likely to bleed and bruise than a patient without lymphoedema. There is a risk of needing a blood transfusion after surgery, although this is rare.

If your haemoglobin levels are low, then I recommend commencing iron tablets (330 mg of ferrous gluconate 3 times a day) for 4 weeks before and after surgery, to help build up and replenish iron stores.

Bruising and swelling: A degree of swelling and bruising is normal and can persist for 6 weeks to 6 months but will constantly improve. Bruising resolves in a matter of weeks.

Haematoma: This is clotted blood that collects in the limb. It is very uncommon as there is no open space to collect fluid/blood. However, if a haematoma does develop it tends to occur within 4 to 6 hours post-surgery. Should the haematoma be significant, it will have to be washed out in theatre and any bleeding vessel(s) identified and cauterised. This does not normally delay your recovery or change the cosmetic result.

Infection: The risk of infection is inherent with any surgical procedure, albeit very uncommon.  You will be given a course of antibiotics to cover you during the healing process.

Numbness, reduced sensation or oversensitivity: A reduction in sensation near the scars occur in most patients and often recovers to some degree, although it may never completely recover.

Contour irregularities and loose skin: It is possible to have indentations and loose skin following this procedure. Skin will contract to some degree, but if you are left with significant laxity, you may require a thigh or arm lift.

Wound healing problems: Blisters or skin necrosis can occur following liposuction. This is rare and should settle with dressings. However, significant skin necrosis may need a small split skin graft.

Patients who are diabetic, take steroids, smoke or use any form of nicotine (inc. substitutes) are at a higher risk of wound healing problems.

Asymmetry: Each limb is slightly different and will continue to be so following surgery; limbs are never identical, and it is common for one to be larger than the other. However, if you have noticeable asymmetry before your surgery then this will be corrected as part of the surgery and will be discussed with you.

Altered sensation: Numbness, pins and needles or a burning sensation often occur as your nerves recover. These symptoms should resolve over a period of up to 6 months.

Further liposuction: This may be necessary to achieve the desired result. Only a certain amount of fat can be removed safely during one operation (maximum of 7 litres). The removal of more than this in one session can put you at risk of fluid shifts and blood loss. If you desire more liposuction then multiple procedures can be planned.

Deep Vein Thrombosis/Pulmonary Embolism (DVT/PE) and Fat Embolism: Following any surgical procedure it is possible to develop a blood clot in your legs, which could potentially break off and travel to your lungs. If the blood clot is large enough, it could prove fatal.

The overall risk for cosmetic surgery is less than 1%, but to reduce any risks of a DVT/PE, you will be provided with special stockings to wear in bed together with a blood thinning injection, if you are not mobile or have previously had a DVT or PE.

More commonly experienced in orthopaedic surgery, but rare in liposuction, fat globules can enter the bloodstream and block circulation causing an embolism. Although most instances of a fat embolism will resolve itself, the condition can become serious, and very occasionally prove fatal.

All the risks outlined above will be discussed in detail at your consultation with me. However, if you have further questions or concerns, please do not hesitate to ask.

Decisions about surgery must never be rushed and requires personal research.

I use a long-acting local anaesthetic to ensure that pain is well controlled after the surgery. The area where the fat is removed is normally tender and painful.

At the end of the procedure, compression garments will be applied to the area to help the skin conform to the new shape and reduce the swelling. These garments are available from the hospital, who will measure you to ensure the correct size is purchased by you.

I would recommend that you obtain 2 garments, as you will want one to wash and one to wear. You should remove the compression garment for at least one hour every day to ensure it is not too tight or causing any problems. You will need to wear your compression day and night for 2 weeks and thereafter you can wear it during the day only until the swelling resolves. Most patients do not require compression in the long-term.

I recommend you stay in hospital overnight following your procedure and go home the following morning, once you are comfortable and able to mobilise.

Before you are discharged from Hospital you will be given a follow up appointment to see the nurse after one week post-operatively.

I normally see you in clinic between 4 and 6 weeks following your procedure, depending on the surgery.

You will not be able to drive yourself home from hospital and, ideally, you should have someone to stay with you for a few days to assist you after your procedure. If you have any concerns during this period, do contact the clinic for advice.

Scar Advice
Once the dressings are removed, I recommend that you massage the incisions, using small circular motions at least twice a day for 5 minutes. You can use any moisturising cream of your choice and apply firm pressure until it blanches.

The scars will also benefit from silicone scar gel (ScarAway® or Kelo-Cote®) twice a day, which will soften and fade them, as well as applying sunblock for 12 months to provide sun protection.

The ScarAway® can be purchased from Healthcare Pharmacy at Governors Square in Grand Cayman.

When you return home, you should take it easy for the first week or so. Most people take about 2 weeks off from work.

The area where the fat is removed is normally tender and painful. Mobilising is encouraged the day after surgery. Noticeable swelling can be expected for up to 6 weeks but will gradually resolve.

You should be able to start driving after 2 weeks and return to the gym when you are comfortable.

For self-funding patients, surgical fees are a combination of the hospital costs, the surgeon, anaesthetic fees and any consumables. I do not charge additional fees for post-op appointments. The fees are based on the surgical time taken to perform the surgery, rather than procedure itself. This means that the costs are calculated fairly.

You will be given a quotation for surgery approximately 48 hours following your consultation.

For lymphoedema patients, your surgery costs may be covered by your health insurance company, dependent upon your policy terms. However, most policies attract a co-pay of 20%, and certain policies will only cover one limb and half of the other, if bilateral surgery is required.

Your fees will be calculated, and you will be informed at your consultation of any potential insurance shortfall, which you will be expected to settle.

Liposuction Patient Information Leaflet