Liposuction for chronic lipoedema

The condition

2.1 Lipoedema is characterised by an abnormal, usually symmetrical, accumulation of fat in the legs, hips, buttocks, and occasionally arms. It is a different condition from obesity and from lymphoedema, which is secondary to obstruction to the lymphatic system. The aetiology of lipoedema is unknown, but hormonal changes, weight gain and genetics are each thought to be involved. Lipoedema is considerably more prevalent in women and very rarely affects men. Symptoms include swollen, heavy legs that are painful to touch and bruise easily. Ankles and feet do not usually have fat accumulation. The size and shape of legs, and the resultant mobility issues and pain, can have a profound effect on quality of life.

Current treatments

2.2 Treatment typically involves healthy lifestyle changes, conservative therapy and, in chronic cases, surgery. The fat associated with lipoedema may be resistant to diet modification and exercise. Conservative therapy, including compression and manual lymphatic drainage (a specialist type of light massage that is mainly used to reduce swelling caused by fluid) can reduce discomfort, improve mobility, and reduce oedema formation by promoting lymphatic return. The main surgical treatment for lipoedema is liposuction. Some people have bariatric surgery to reduce weight from areas of the body not affected by lipoedema, or to prevent further weight gain in those who are obese.

The procedure

2.3 The aim of liposuction for lipoedema is to reduce limb bulk, reduce pain, and to improve mobility and functioning. Liposuction for chronic lipoedema can be done under general or local anaesthesia. Several small incisions are made in the limb. Modern liposuction usually involves infiltrating the limb with large volumes of fluid (tumescence) to allow the cannula to glide through the tissue with minimal damage to blood vessels and lymphatics. Tumescent liposuction needs an infiltration pump to deliver the tumescent fluid. Cannulas, connected to a vacuum pump, are then inserted into the incisions and oedematous adipose tissue is removed by vacuum aspiration. Using vibrating cannulas (power-assisted liposuction) or water-jet-assisted liposuction can help remove fat more easily. Water-jet-assisted liposuction needs less initial infiltration because fluid is simultaneously infiltrated and aspirated during liposuction. Liposuction is done around and all the way along the limb. In tumescent liposuction, both fat and tumescent fluid are suctioned out together.

2.4 The procedure can take 1 to 4 hours depending on the size of the treatment area. Immediately after liposuction, a compression bandage is applied to the limb to control any bleeding and to prevent postoperative oedema. Antibiotics are typically prescribed as prophylaxis after the operation. When the wounds are healed after the procedure, a custom-made compression garment is worn. This garment is typically revised and refitted multiple times during the first year until the oedema volume has been reduced as much as possible.