Swedish Doctor Uses Liposuction

Liposuction Successful In Treating Chronic Arm Lymphedema

Reduction of chronic non-pitting arm lymphedema can be achieved through use of liposuction techniques, according to a plastic surgeon from Sweden who says the treatment effect lasts for years.

Hakan Brorson, MD, head of the lymphedema unit in the department of plastic and reconstructive surgery at Malmo University Hospital, said he treated 70 patients with his liposuction procedure. His patients, he explained, have had complete reduction of the characteristic swelling associated with lymphedema -- and there has been no recurrence over seven years.

"By removing excess adipose tissue with liposuction, a complete reduction is possible," Dr. Brorson said at the 4th National Lymphedema Network conference, in Orlando, FL.

"This is a highly controversial and highly invasive procedure," said Paula Stewart, MD, assistant professor of medicine at the University of North Carolina-Chapel Hill, who moderated the oral presentation session at which Dr. Brorson detailed data on 12 of his patients. Dr. Stewart cautioned that physicians who attempt the procedure should only perform it in the context of clinical investigations.

Most physicians admonish practitioners not to even perform needle sticks in the affected arm of patients with lymphedema, the common, disfiguring and sometimes disabling complication that follows breast cancer surgery and/or radiation treatments. Dr. Brorsonís proposal of invading the swollen arm through an incision with a liposuction canula clearly disturbed the audience of patients, therapists and physicians.

"I only make a small incision," said Dr. Brorson in response to questions, "and I give the patients one to two weeks of antibiotics after the procedure. I have not had any infections develop." In fact, he said, he had no surgical complications at all in his patients.

He also demonstrated that by carefully selecting patients who have excess adipose tissue, the lymphedema can be controlled. In his report, Dr. Brorson said he removed about 2 liters of tissue and fluid from the arms of the women in his study. More than 80 percent of the tissue was fat and less than 20 percent was lymph fluid, he said. Magnetic resonance imaging scans of the arm before and after the treatment confirmed the removal of the fat, he said.

Once the excess fluids and tissue are removed from the arm, the patients are advised to wear standard compression garments, which maintain the now normal-looking limb. His patients are limited to "non-pitting lymphedema".

When a physician presses on the swollen arm with his thumb, patients who have mainly fluid retention will show an obvious depression in the flesh. Those who have high fat content in the arm will not show the finger "pit" and would be candidates for liposuction, Dr. Brorson explained.

He said his laboratory work suggests that fatty tissue in the arm continue to build up and accumulate in patients with chronic lymphedema. In his study, the average person had been treated with cancer at age 50 and the average patient had lived with lymphedema for about 14 years before undergoing liposuction.

He said that the patients who are candidates for liposuction would have already failed to have excess fluid removed through standard health care procedures.

Dr. Stewart said that many plastic surgeons in the United States have traveled to Sweden to learn the technique from Dr. Brorson and his colleagues and are now performing the procedures. However, "no one would suggest -- not even Dr. Brorson -- that liposuction should be used as a first line therapy. Other treatments should be used first."

By Ed Susman Thanks to DG News


From: Reducing Surgical Trauma to the Axilla-Lymphedema Information

Federation of European Cancer Societies


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