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    Overview

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    Existing assessments of this procedure

    In 2021, results of consensus conference on the surgical treatment of lymphoedema were published (Chang, 2021). Consensus statements were informed by a systematic review and meta-analysis. The results of this meta-analysis are described in Chang, 2021, in the Summary of key evidence. The strength of recommendations was assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework, where recommendations are classified as strong (grade 1) or weak (grade 2). Recommendations were further classified as A, B, or C based on the quality of evidence informing the recommendation. There were 2 recommendations made relevant to this procedure:

    • Debulking procedures such as liposuction are effective in addressing nonfluid component such as fat involving lymphoedema (grade 1C).

    • There is a role for liposuction combined with physiologic procedures, although the timing of each procedure is currently unresolved (grade 1C).

    In 2020, the Executive Committee of the International Society of Lymphology published a consensus update on the diagnosis and treatment of peripheral lymphoedema (Executive Committee of the International Society of Lymphology, 2020). This update was based on discussions at several International Congress of Lymphology meetings. The consensus statement notes that 'liposuction (or suction-assisted lipectomy) using a variety of methods has been shown to completely reduce non-pitting, primarily non- fibrotic, extremity lymphedema due to excess fat deposition (which has not responded to non-operative therapy) in both primary and secondary lymphoedema'. Further, that 'even patients with signs of fibrosis can benefit from the procedure when using power-assisted liposuction'. The statement cautions that 'this surgical technique and follow-up are very different from cosmetic liposuction and should be performed by an experienced team' and that liposuction 'does not alter the need for compression therapy beyond appropriate garment after surgery'.

    In 2017, the American Society of Breast Surgeons published recommendations from an expert panel on the diagnosis, prevention, and treatment of breast cancer-related lymphoedema (McLaughlin, 2017). The expert panel agree that 'lymphatic liposuction with long-term compression is effective for severe late-stage breast cancer-related lymphoedema unresponsive to conservative management.'

    In 2011, the Institut national d'excellence en santé et en services sociaux (INESSS) published a systematic review on treatment of cancer-related secondary lymphoedema (Larouche, 2011). The report notes that 'liposuction may be somewhat effective for a very specific type of secondary lymphedema, especially advanced stage 2 lymphoedema'. However, the report cautions that, at the time of publication, liposuction 'treatment is still experimental' and that 'it is essential for patients to wear compression garments permanently (24 hours a day) after the operation to maintain volume reductions.'