title: Liposuction for Advanced Lymphedema: A Multidisciplinary Approach for Complete Reduction of Arm and Leg Swelling.
abstract: OBJECTIVE
  This research describes and evaluates a liposuction surgery and multidisciplinary rehabilitation approach for advanced lymphedema of the upper and lower extremities.
  
  
  METHODS
  A prospective clinical study was conducted at an Advanced Lymphedema Assessment Clinic (ALAC) comprised of specialists in plastic surgery, rehabilitation, imaging, oncology, and allied health, at Macquarie University, Australia. Between May 2012 and 31 May 2014, a total of 104 patients attended the ALAC. Eligibility criteria for liposuction included (i) unilateral, non-pitting, International Society of Lymphology stage II/III lymphedema; (ii) limb volume difference greater than 25 %; and (iii) previously ineffective conservative therapies. Of 55 eligible patients, 21 underwent liposuction (15 arm, 6 leg) and had at least 3 months postsurgical follow-up (85.7 % cancer-related lymphedema). Liposuction was performed under general anesthesia using a published technique, and compression garments were applied intraoperatively and advised to be worn continuously thereafter. Limb volume differences, bioimpedance spectroscopy (L-Dex), and symptom and functional measurements (using the Patient-Specific Functional Scale) were taken presurgery and 4 weeks postsurgery, and then at 3, 6, 9, and 12 months postsurgery.
  
  
  RESULTS
  Mean presurgical limb volume difference was 45.1 % (arm 44.2 %; leg 47.3 %). This difference reduced to 3.8 % (arm 3.6 %; leg 4.3 %) by 6 months postsurgery, a mean percentage volume reduction of 89.6 % (arm 90.2 %; leg 88.2 %) [p < 0.001]. All patients had improved symptoms and function. Bioimpedance spectroscopy showed reduced but ongoing extracellular fluid, consistent with the underlying lymphatic pathology.
  
  
  CONCLUSIONS
  Liposuction is a safe and effective option for carefully selected patients with advanced lymphedema. Assessment, treatment, and follow-up by a multidisciplinary team is essential.
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine and Health Sciences, 2 Technology Place, Macquarie University, Sydney, NSW, Australia. john.boyages@mq.edu.au.|Genesis Cancer Care, Macquarie University Hospital, 3 Technology Place, Macquarie University, Sydney, NSW, Australia. john.boyages@mq.edu.au.
authors.forename: John
authors.initials: J
authors.lastname: Boyages
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine and Health Sciences, 2 Technology Place, Macquarie University, Sydney, NSW, Australia.
authors.forename: Katrina
authors.initials: K
authors.lastname: Kastanias
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine and Health Sciences, 2 Technology Place, Macquarie University, Sydney, NSW, Australia.
authors.forename: Louise A
authors.initials: LA
authors.lastname: Koelmeyer
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine and Health Sciences, 2 Technology Place, Macquarie University, Sydney, NSW, Australia.
authors.forename: Caleb J
authors.initials: CJ
authors.lastname: Winch
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine and Health Sciences, 2 Technology Place, Macquarie University, Sydney, NSW, Australia.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Lam
authors.affiliation: Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia.
authors.forename: Kerry A
authors.initials: KA
authors.lastname: Sherman
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine and Health Sciences, 2 Technology Place, Macquarie University, Sydney, NSW, Australia.|Department of Plastic Surgery, Ninewells Hospital, Dundee, UK.
authors.forename: David Alex
authors.initials: DA
authors.lastname: Munnoch
authors.affiliation: Plastic and Reconstructive Surgery, Department of Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden.
authors.forename: Håkan
authors.initials: H
authors.lastname: Brorson
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine and Health Sciences, 2 Technology Place, Macquarie University, Sydney, NSW, Australia.
authors.forename: Quan D
authors.initials: QD
authors.lastname: Ngo
authors.affiliation: The Clinic Physiotherapy, Macquarie University Hospital, 2 Technology Place, Macquarie University, Sydney, NSW, Australia.
authors.forename: Asha
authors.initials: A
authors.lastname: Heydon-White
authors.affiliation: Macquarie Medical Imaging, Macquarie University Hospital, 3 Technology Place, Macquarie University, Sydney, NSW, Australia.
authors.forename: John S
authors.initials: JS
authors.lastname: Magnussen
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine and Health Sciences, 2 Technology Place, Macquarie University, Sydney, NSW, Australia.|Mt. Wilga Rehabilitation Hospital, Hornsby, NSW, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Mackie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001132:Arm / Q000473:pathology*; D001943:Breast Neoplasms / Q000473:pathology / Q000534:rehabilitation* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058025:Interdisciplinary Studies; D007866:Leg / Q000473:pathology*; D015187:Lipectomy; D008209:Lymphedema / Q000150:complications / Q000628:therapy*; D008875:Middle Aged; D009367:Neoplasm Staging; D010348:Patient Care Team; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D055815:Young Adult