Liposuction of Breast Cancer-Related Arm Lymphedema Reduces Fat and Muscle Hypertrophy

Abstract

Introduction: Adipose tissue deposition is a known consequence of lymphedema. A previous study showed that the affected arm in patients with nonpitting breast cancer-related lymphedema (BCRL) had a mean excess volume of 73% fat and 47% muscle. This condition impairs combined physiotherapy as well as more advanced microsurgical methods. Liposuction is, therefore, a way of improving the effects of treatment. Objective: This study aims to evaluate the tissue changes in lymphedematous arms after liposuction and controlled compression therapy (CCT) in patients with nonpitting BCRL. Methods and Results: Eighteen women with an age of 61 years and a duration of arm lymphedema (BCRL) of 9 years were treated with liposuction and CCT. Tissue composition of fat, lean (muscle), and bone mineral was analyzed through dual energy X-ray absorptiometry (DXA) before, and at 3 and 12 months after surgery. Excess volumes were also measured with plethysmography. The median DXA preoperative excess volume was 1425 mL (704 mL fat volume, 651 mL lean volume). The DXA excess volume at 3 months after surgery was 193 mL (-196 mL fat volume, 362 mL lean volume). At 12 months after surgery, the median excess DXA volume was 2 mL (-269 mL fat volume, 338 mL lean volume). From before surgery to 3 months after surgery, the median DXA excess volume reduced by 85% (p < 0.001) (fat volume reduction 128% (p < 0.001), lean volume reduction 37% (p = 0.016)). From before surgery to 12 months after surgery, it reduced by 100% (p < 0.001) (fat volume reduction 139% [p < 0.001], lean volume reduction 54% [p = 0.0013]). Conclusions: Liposuction and CCT effectively remove the excess fat in patients with nonpitting BCRL, and a total reduction of excess arm volume is achievable. A postoperative decrease in excess muscle volume is also seen, probably due to the reduced weight of the arm postoperatively.

Liposuction and Controlled Compression Therapy Reduce the Erysipelas Incidence in Primary and Secondary Lymphedema

“…The underlying reason for the reduction in erysipelas can be speculated to be a result of better skin blood flow and skin management, continuous wearing of garments in combination with a reduction in the amount of adipose tissue that could enhance bacterial overgrowth. [7][8][9]41,53 In general, our results show a lower incidence rate of erysipelas compared with the existing literature. 20,21,50,54 The difference observed in this study compared with previous studies could reflect the fact that our observation started at lymphedema debut.…”

“…The underlying reason for the reduction in erysipelas can be speculated to be a result of better skin blood flow and skin management, continuous wearing of garments in combination with a reduction in the amount of adipose tissue that could enhance bacterial overgrowth. 7–9,41,53…”

“…1 Lymphedema results in an inflammatory process leading to adipose tissue deposition, predominantly subcutaneous in the lymphedematous tissue, but to a small extent also subfascial in the muscle. [2][3][4][5][6][7][8][9][10] At this stage (corresponding to the International Society of Lymphology grading system stages II & III 11 ), the excess volume cannot be reduced solely using conservative measures or microsurgical procedures because these treatment modalities aim to remove the fluid component of the lymphedema, not the adipose tissue. Therefore, liposuction has been introduced as a method of treatment in late-stage lymphedema, with excellent long-term results.…”

Complete Reduction of Leg Lymphedema after Liposuction: A 5-Year Prospective Study in 67 Patients without Recurrence

“…This is in accordance with a previously published study evaluating patients with breast cancer-related lymphedema using dual-energy X-ray absorptiometry. 54 Adipose tissue as well as lean tissue (muscle, fluid, skin, etc) were seen to gradually decrease for 1 year after liposuction. One possible explanation is that an enlarged limb is heavy, and therefore, muscle mass increases due to the added load.…”

Multi-omics characterization of lymphedema-induced adipose tissue from breast cancer patients

“…Arm LE is a common complication after surgical removal of axillary lymph nodes for breast cancer treatment [30][31][32][33] . Neither CDT nor microsurgical reconstruction can be used in later stages of LE as none of the techniques can remove the hypertrophied adipose tissue that occurs in response to lymph stasis and inflammation 30,31,33 . In later stages of non-pitting LE, which does not respond to conservative treatment, liposuction, combined with postoperative CCT, gives a complete reduction of the excess volume [12][13][14][15][16] .…”