Focus of the Report: This report focuses on the use of liposuction (also called suction-assisted lipectomy) for the surgical treatment of patients with lymphedema.

Technology Description: Liposuction is a reductive, minimally invasive, surgical procedure used to remove hypertrophied adipose tissue that accumulates in an affected limb or submental region of patients with chronic, nonpitting lymphedema. Physiological microsurgical interventions, such as lymph node transfer (LNT) and lymphovenous anastomosis (LVA), which attempt to restore adequate lymphatic function, can reduce the volume of excess lymphatic fluid in the affected limb(s) in early stages of the disease. Late-stage lymphedema may not respond to standard complex decongestive therapy (CDT), LNT, or LVA. For patients with late-stage disease, liposuction and debulking surgery are options. Liposuction is carried out under local or general anesthesia. After surgery, patients with extremity lymphedema must use compression garments continuously to maintain volume reduction because liposuction does not treat the cause of lymphedema.

Controversy: As with all surgeries, liposuction is inherently invasive and poses some risks. The long-term outcomes of liposuction for lymphedema have not been well characterized. Also, the role of liposuction, other forms of lymphedema surgery, and adjunctive supportive treatment (e.g., compression garments, ongoing CDT) have not been well defined in comparative studies.

Key Questions:

  • Is liposuction effective in treating patients with lymphedema who have not responded to conservative therapy?

  • How does liposuction compare with conservative interventions, CDT, or an alternative non-liposuction microsurgical technique for treatment of lymphedema?

  • Is liposuction safe in patients with lymphedema?

  • Have definitive patient selection criteria been identified for liposuction in patients with lymphedema?

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