Purpose: Lymphedema liposuction is an effective and time-tested treatment. However, it is uncertain whether the technique causes lymphatic injury. In this study, we compare lymphatic function pre- and post-liposuction using indocyanine green (ICG) lymphography and patient reported outcomes.
Methods: All patients with solid-predominant lymphedema who were treated during the study period of January 2020 and June 2022 were evaluated. Patients with previous lymphatic procedures such as liposuction or lymphaticovenous bypass were excluded. All patients were assessed preoperatively and at predefined postoperative time intervals using patient-reported baselines/outcomes and ICG lymphography.
Results: We analyzed 96 patients, primarily females (n=90). Median age at time of procedure was of 69.5 years, with an 8-year average symptom duration. 31 patients had primary lymphedema, and 51 of 62 patients with secondary lymphedema had previous nodal removal. Lymphedema affected the upper limbs in 36 patients and the lower limbs in 60 patients. Mean lipoaspirate volumes were 3731 mL and 2728 mL, respectively.
Average follow-up was 6 months (range: 3-17 months) using ICG lymphography. All patients showed progressive lymph drainage improvement. At the 3-month mark, 93% (65 out of 70) displayed improvement, and this figure increased to 95% (35 out of 37) at the 6-month assessment and 100% at one-year follow up. All patients showed enhanced patterns and reported substantial relief of their symptoms by the last follow-up.
Conclusion: Treating extremity solid-predominant lymphedema with liposuction does not worsen lymphatic function. Paradoxically, it induces progressive and sustained improvement in lymph drainage.