PURPOSE: Liposuction is an effective treatment for solid-predominant lymphedema by debulking pathologic tissue. Although studies demonstrate significant volume reduction and improvement in patient reported outcomes, there is concern that liposuction can lead to further lymphatic injury. This study investigates lymphatic drainage following liposuction using indocyanine green (ICG) lymphography. We hypothesize that following liposuction, there is not only improvement in lymphatic function in the operative limb but also systemically in other affected areas.
METHODS: All primary lymphedema patients who underwent lymphedema liposuction between January 2020 to April 2022 were included. Patients who underwent previous lymphatic procedures or those without follow up imaging were excluded. All patients underwent standardized diagnostic and tracking protocol including patient reported outcomes, limb circumference measurements, and ICG lymphography pre-operatively and post-operatively.
RESULTS: 25 patients were included in our analysis, 22 females and 3 males. The average age was 52.2 ± 17.2 years old, with average BMI of 27.0 ± 4.9. 88% (n=22) were symptomatic in the lower extremities, 8% (n=2) complaining of bilateral upper extremity swelling, 4% (n=1) with swelling in all four extremities. Total of 25 limbs underwent lymphedema liposuction, 23 lower extremities and 2 upper extremities. On average, 2.7 ± 1.3 L of lipoaspirate was removed. 64% (n=16) underwent skin reduction as well. Mean follow up was 5.8 ± 3.7 months (range 3-18 months). No complications were seen. When comparing pre-operative ICG to post-operative ICG, 100% (n=25) had improvement in lymphatic flow in the operative limb (p < 0.001), with reduction in pathologic and/or emergence of normal lymphographic patterns. Interestingly, 96% (n=24) had improvement in lymphatic flow in at least 1 non-operative limbs as well (p < 0.001).
CONCLUSION: We have demonstrated that liposuction does not lead to further lymphatic injury, rather we found improvement in lymphatic function post-operatively. Counter to current belief, we have also found there is systemic improvement in lymphatic drainage, not just isolated to the surgical limb.