As lymphoedema swelling becomes established, the body begins laying down fat in the affected tissues. This transformation is a non-reversible process, and the fat cannot be reduced by normal weight loss techniques. If your lymphoedema no longer improves when your leg is elevated, or in response to compression garments, then you may have progressed to this more advanced stage of the condition.
It is still important to maintain the treatment measures put in place by your lymphoedema therapist, in order to control symptoms and prevent the condition from progressing further. However, these will not reduce the size of the limb. You may then be referred to a surgeon to consider reducing the extra fat tissue through surgery.
Liposuction is a surgical procedure that involves multiple key-hole incisions. Through these, a hollow tube (known as a cannula) is inserted into the limb. Fat is drawn into the cannula by attached vacuum tubing, and removed from the body. Other important structures, such as nerves, blood vessels and lymphatics, are left behind.
Liposuction is a powerful technique that quickly reduces limb size. It has also been shown to reduce rates of infection, and improve the effectiveness of garments (but garment freedom is rare).
Patients need to stay in hospital for a few days afterwards for dressings, pain relief, and to monitor for post-operative issues. Liposuction leaves behind a lot of deflated loose skin, which must slowly contract to match the limb. Lymphoedema therapist input is critical to the surgical result.
In severe cases, modern liposuction may not meet the challenge. In such circumstances, very large amounts of lymphoedema tissue can be removed by direct surgical excision. This removes not only fat, but also skin and any blood vessels or nerves within. Large long surgical scars are unavoidable. Various techniques have been used over the decades, all of which have drawbacks – direct excision is therefore generally reserved as a last-line surgical option.
The very first case performed by the National Lymphatic Surgery Service was a humanitarian case performed in November 2024. This 55 year old man from American Samoa presented with extreme lymphoedema of his right leg. With a combination of intensive lymphoedema therapist care and direct surgical excision, we were able to give him mobility, dignity and quality of life. He has kindly shared his story to raise awareness of lymphoedema care in New Zealand.
https://www.rnz.co.nz/news/national/534169/it-was-unrecognisable-as-a-leg-man-s-life-changing-surgery
Left: First appointment May 2023 | Right: 1 week post operative November 2024
