Lymphatic surgery: Lipedema / Lymphedema

Frequently asked questions:

• What is lipedema?
• What causes lipedema?
• How does lipedema develop?
• How can lymphoedema be treated?
• When should liposuction be performed for lipoedema?
• How should liposuction be performed for lipoedema?
• What are the results of liposuction after lipedema?
• Does health insurance cover the costs of liposuction?
• How does liposuction for lipedema work?
• What needs to be considered after liposuction?
• Further questions about lipoedema?

Lipedema almost exclusively affects women. The main characteristic is that the upper body remains slim, while the legs become disproportionately thick. Later on, pain and water retention are added to this and those affected tend to develop bruises very quickly after even the slightest touch.

The water retention in the tissue associated with lipedema is caused by compression of the venous and lymphatic drainage due to the increase in fatty tissue. The large lymph vessels are not initially affected.

The lymph vessels are still intact in the early stages of the disease. However, the increase in the lymphatic load (fluid and proteins) becomes too great in the further course of the disease, so that the system collapses and protein-rich lymphoedema develops.

It is also being discussed that an inflammatory cascade and abnormal sympathetic innervation of the increased fatty tissue are responsible for the pain complained of.

Before the diagnosis is confirmed, most of those affected have gone through years of frustrating dieting, culminating in an eating disorder.

If lymphoedema is present, the lymphatic drainage is impaired, which is why the lymph fluid can no longer be removed from the tissue. Lymph congestion leads to chronic swelling and hardening of the tissue.

Patients with lymphoedema have a feeling of tension and pain in the affected area in addition to an increase in circumference and can be significantly restricted in their daily life and quality of life as a result. In addition, conservative therapy is very time-consuming and must be carried out regularly. In the course of the disease, inflammation can further worsen the findings.

Until now, conservative measures such as manual lymphatic drainage and compression garments were usually the only treatment options for patients.

Basically, there is primary (congenital) or secondary (acquired) lymphoedema. Secondary lymphoedema usually affects the arms and/or legs after radical tumor surgery with lymph node removal or after radiotherapy.

Statistically, around 20% of all women have problems with arm lymph drainage after lymph node removal for breast cancer.

Surgical procedure

Creation of lymphovenous anastomoses using the “supermicrosurgery technique”

As part of super-microsurgical lymphatic surgery, a blocked lymph vessel is microsurgically sutured to a superficial vein under the microscope under maximum magnification. This allows the lymph to drain via the vein and reduces the swelling of the affected area.

To locate the small, transparent lymphatic vessels, a photodynamic infrared camera examination is performed before and during the operation without radiation exposure. We perform this procedure at the LUKS.

Microsurgical lymph node transfer

In the case of chronic lymphoedema, lymph node transplantation can still bring about an improvement.

Here, lymph nodes are removed from the groin with their own blood supply as a free tissue transfer and transplanted into the affected area.

In the long term, new lymph channels sprout from these displaced lymph nodes, which remove the accumulated lymph.

Risks

Since the skin incisions are only 1-2 cm, the surgical risk is very low. In general, there is an increased risk of infection with a lymphatic drainage disorder, which is why we operate with antibiotic prophylaxis.

Ablative procedures: Liposuction

In cases of advanced lymphoedema with fibrotic tissue changes, circumferential reduction by liposuction can bring about an improvement. Compression should continue postoperatively.

In the case of tumor patients, the costs are covered on the basis of a medical indication; in all other pronounced cases, I issue a cost approval.