Liposuction

Liposuction

PEP Topic 
Lymphedema
Description 

Liposuction is an operation that removes fat from the body. The most common method involves insertion of a small cannula attached to a vacuum device. Fat is removed by suction. Liposuction was examined for its effect on lymphedema in patients with cancer.

Effectiveness Not Established

Research Evidence Summaries

Boyages, J., Kastanias, K., Koelmeyer, L.A., Winch, C.J., Lam, T.C., Sherman, K.A., . . . Mackie, H. (2015). Liposuction for advanced lymphedema: A multidisciplinary approach for complete reduction of arm and leg swelling. Annals of Surgical Oncology, 22, 1263–1270. 

doi: 10.1245/s10434-015-4700-3
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Study Purpose:

To evaluate a liposuction surgery and multidisciplinary rehabilitation approach for advanced lymphedema of the upper and lower extremities

Intervention Characteristics/Basic Study Process:

Liposuction was performed under general anesthesia following limb exsanguination and tourniquet application. Using specialized Helixed Tri-Port III cannulas (22 and 30 cm long, 4–5 mm wide) connected to a vacuum pump, subcutaneous tissue was removed through multiple small incisions along the limb. Presurgical limb volume determined how much tissue was removed to equalize volume relative to the unaffected limb. Compression garments were applied to the affected limb immediately postsurgery prior to tourniquet release (custom-made 30 mmHg JOBST® Elvarex for arms, or Ready Wraps® [Solaris] for legs). From one week postsurgery, all leg patients wore JOBST Elvarex custom-made compression garments 50–80 mmHg. Initial postsurgical garments were measured using the circumference of the unaffected limb. Subsequent measurements were obtained from the operated limb by a trained garment fitter. Every order consisted of two garments, allowing one to be worn while the other was washed. Throughout follow-up, compression garments alone were used in areas where liposuction was performed. However, decongestive lymphatic therapy was used when indicated in areas where liposuction was not performed (hands or feet) or areas that could not be adequately compressed (shoulder or hip).

Sample Characteristics:

  • N = 21 (15 arm and six leg)
  • MEAN AGE = 57.8 years (range = 25–69 years) in arm group; 50.7 years (range = 18–66 years)
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: Cancer-related secondary lymphedema
  • OTHER KEY SAMPLE CHARACTERISTICS: Cancer-related secondary lymphedema was a more common reason for liposuction (85.7%) than primary (congenital) lymphedema (14.3%) with breast cancer treatment being the most common underlying cause (66.7%). The mean time of longstanding lymphedema was 9.1 years (range = 2–29 years) in the arm group versus 15.5 years (range = 3–42 years) in the leg group. 

Setting:

  • SITE: Single site    
  • SETTING TYPE: Multiple settings
  • LOCATION: Australia

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Late effects and survivorship
  • APPLICATIONS: Elder care

Study Design:

Prospective clinical study, one arm, pre and post measures

Measurement Instruments/Methods:

  • Limb volume by tape was calculated using 4 cm truncated cone circumferential measurements
  • Lymph fluid measured by bioimpedance spectroscopy (L-Dex®) measurement
  • Functional and emotional impairment was assessed using the Patient-Specific Functional Scale (PSFS). PSFS is reliable and valid across contexts and sensitive to change in breast cancer survivors, but it was not previously validated for lymphedema.

Results:

A significant postliposuction reduction in limb volume was achieved for all patients. The mean preoperative limb difference was 45.1% (range = 23–83), decreasing between two and six weeks postsurgery to 13.2% (range = -2–24), a significant 68.2% reduction (range = 35–104; t[20] = 9.66; p < 0.001). Limb volume difference reduced to 3.8% by six months postsurgery, an 89.6% (range = 38–149) reduction of presurgical volume (t[18] = 9.17; p < 0.001). This near-complete reduction was maintained to 12 months (n = 8), a 97.7% reduction (range = 73–123; t[8] = 5.73; p < 0.001). Mean presurgical limb volume difference was 45.1% (arm 44.2%; leg 47.3%). L-Dex increased four weeks postsurgery to 55 (range = 32–73), reflecting the extracellular fluid associated with postsurgical swelling (t[18] = -2.51; p = 0.02). Functionally, all patients reported improvements on the PSFS index of personally important activities by six months postsurgery (p < 0.01). 

Conclusions:

Liposuction was safe and may be an effective option for carefully selected patients with advanced lymphedema. Assessment, treatment, and follow-up by a multidisciplinary team is essential.

Limitations:

  • Small sample (< 30)
  • Baseline sample/group differences of import 
  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment) 
  • Risk of bias (no appropriate attentional control condition)  
  • isk of bias (sample characteristics)
 

Nursing Implications:

Liposuction is a surgical approach to lymphedema. It should be noted that even with continuous compression therapy, postliposuction, patients’ lymph fluid level was elevated beyond normal. Nurses should continue observing the impact of liposuction on patients’ physiological, functional, and emotional aspects. Nurses should also advise patients according to current evidence.

Schaverien, M.V., Munro, K.J., Baker, P.A., & Munnoch, D.A. (2012). Liposuction for chronic lymphoedema of the upper limb- 5 years of experience. Journal of Plastic, Reconstructive & Aesthetic Surgery, 65, 935–942.

doi: 10.1016/j.bjps.2012.01.021
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Study Purpose:

To describe the five-year follow-up results of the use of liposuction for arm lymphedema after breast cancer treatment

Intervention Characteristics/Basic Study Process:

Patients who had chronic arm lymphedema who were compliant with use of compression garments were referred for liposuction surgery. Study questionnaires and limb volume measures were performed pre- and postoperatively. Limb volume was measured at 2 and 4 weeks postoperatively and at 3 months, 6 months, and yearly for 5 years. Specific liposuction technique was described. Patients had a custom-made pressure garment applied at the time of the surgery.  All received 5-day courses of antibiotics, analgesia, and limb elevation. Patients were discharged on day 4.

Sample Characteristics:

  • The study reported on 12 patients who were followed for one year. Only two patients were available for follow up in the fifth year.
  • The mean age of patients was 48 years with a range of 38–60 years.
  • The sample was 100% female.
  • All of the patients had breast cancer. Lymphedema developed at an average of one year after initial surgery, and mean duration was 7 years.
  • Eleven of the patients received axillary dissection, while one developed lymphedema after subsequent thyroidectomy. 
  • Most of the patients had received adjuvant radiation or chemotherapy.

Setting:

The study was conducted at a single site, inpatient and outpatient setting, in the United Kingdom.

Phase of Care and Clinical Applications:

  • Patients were undergoing long-term, follow-up care.
  • The study has clinical applicability for late effects and survivorship.

Study Design:

This study involved prospective analysis.

Measurement Instruments/Methods:

  • The Hospital Anxiety and Depression Scale (HADS) was used.
  • A visual analog scale (VAS) was used to measure overall well being.
  • Arm volume was measured using conal measurement at 4-cm intervals.

Results:

No surgical complications occurred. The mean percent reduction in arm volume after surgery was 84%. At one year after surgery, the mean volume difference between operated and unaffected arms was 29 ml. At two years, a mean volume ratio of the operated to nonoperated arm of 0.98 was found, demonstrating that volumes were virtually the same.  In 11 patients, postoperative anxiety scores declined (p = 0.049). Researchers noted that ongoing compliance with use of compression garments was essential to continued effect.

Conclusions:

Findings suggest that liposuction and ongoing use of compression garments may be a promising approach to manage upper extremity lymphedema in patients after surgery for breast cancer.

Limitations:

  • The sample size was small with fewer than 30 participants.
  • No comparison or control group was included; however, these results are shown in patients who had prior unsuccessful standard treatments for lymphedma.

Nursing Implications:

Further research into this intervention is needed to further validate these findings in comparison with other approaches.  Liposuction may have some benefit for patients with lymphedema that is not adequately controlled by other means.  The procedure for this application is very specific and requires specific surgical training in this technique.

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