"Due to my extremely positive experience I have many friends and family members now considering procedures that they had long put off for fear of not having someone like Dr. Granzow care for them."Read More
"Thank you and your staff for taking such wonderful care of me... you know it was a success when I find myself saying, 'Why didn't I do this earlier?'"Read More
"Thank you so much for your attention to detail and your meticulous hand in surgery... I appreciate your care, concern, and follow-up."Read More
Dr. Granzow is a Board Certified Plastic Surgeon who is a specialist in the diagnosis and treatment of lymphedema. He is an internationally known expert in the field and performs the three modern types of surgery to correct this condition, which include microsurgical lymph node transfer, lymphaticovenous anastomosis, and Suction-Assisted Protein Lipectomy (SAPL), also known as lymphatic liposuction.
This website is dedicated to providing combined surgical and other treatment options as a long-term solution for patients. Dr. Granzow is a pioneer in the field, and he personally performs these surgeries in private hospitals in the Los Angeles area of California. He was the first to effectively combine different types of surgery to treat the condition’s fluid and solid components in the same patient. He developed the FLO System (SM) of Functional Lymphedema Operations, the first comprehensive treatment system to integrate the different surgical and non-surgical treatment methods.
Dr. Granzow reviewed current surgical approaches at the September 2012 National Lymphedema Network Conference in Dallas, Texas. There was tremendous interest in this topic and we have included answers to some of the more commonly asked questions on our Frequently Asked Questions page.
This condition has different presentations that require different types of surgical and non-surgical treatment. There is no single method of treatment or surgery that is best for all varieties.
During your consultation, Dr. Granzow will evaluate your condition carefully to determine which type of procedure best matches your specific circumstance. We work closely with lymphedema therapists both at our center and with you at home to optimize your long-term results.
It is important to note that Dr. Granzow has dedicated significant amounts of time to research and investigation of surgical treatment techniques. He actively maintains memberships in organizations and societies that promote safe and effective treatment. He not only routinely corresponds with recognized leaders in the field in the United States and throughout the world but also has spent time with them in their institutions learning the latest techniques and therapies.
It is critical that any surgeon you choose to perform surgery keeps up with the latest research and developments achieved by multiple authorities. You must specifically ask your surgeon about their knowledge and affiliations to confirm that they have trained with all of the different leaders in the field.
SURGICAL TREATMENT OPTIONS
Multiple different and effective surgical treatments now exist for this condition, and each must be chosen specifically for the proper patient. Some procedures, like Vascularized Lymph Node Transfer (vLNT) are relatively new. Other procedures, such Lymphaticovenous Anastomosis (LVA), have been described previously and have been improved significantly in recent years to yield better results.
The choice of technique for each patient is critical, and no one type of technique will fit each individual’s condition. Suction-Assisted Protein Lipectomy (SAPL), which is different from standard liposuction, may be required if significant amount of fat and protein are present in an affected arm or leg.
Dr. Granzow has studied multiple types of surgical techniques with the leaders in the field to best recommend the procedure which will maximize your benefit while minimizing the risk of surgery. He works closely with trained lymphedema therapists to maximize the overall outcome. He was the first to combine different surgical treatments specifically to address both the solid and fluid components of swelling, dramatically decreasing both arm size and the amount of compression required.
These techniques are performed only by a small handful of highly specialized surgeons worldwide. Dr. Granzow is a pioneer in this area and works with colleagues from around the world continually to further refine these procedures. As a faculty member in the prestigious UCLA Division of Plastic Surgery, he actively teaches residents, fellows, and students in his role as Assistant Chief of Plastic Surgery at Harbor-UCLA Medical Center.
SAFETY OF SURGICAL TREATMENT
Dr. Granzow practices only the most modern surgical techniques that are completely different from the previously disfiguring procedures performed in the past. He has gone to great lengths to incorporate the highest levels of safety into his modern techniques to prevent the condition from worsening from the surgery or developing at a lymph node donor site.
THE FLO SYSTEM
The FLO System (SM) of Functional Lymphedema Operations was created by Dr. Granzow to incorporate the different modern types of surgeries to provide a consistent and unified treatment regimen of procedures to best treat each patient. Currently, Suction-Assisted Protein Lipectomy (SAPL) may be used to treat the large amounts of accumulated solids in an arm or leg affected by the condition. Both vascularized lymph nodes transfers (VLNT) and lymphaticovenous anastomosis (LVA) are used to remove the fluid component and to prevent their future re-accumulation. Each procedure is effective in different situations. Dr. Granzow will review which procedure(s) may be best suited for your individual situation. The system is a dynamic tool that will evolve and change as new technology is introduced in the future.
VASCULARIZED LYMPH NODE TRANSFER (VLNT)
Vascularized Lymph Node Transfers have been shown to be an effective method for the treatment of the arm. Lymph nodes are taken from the groin area with their supporting blood vessels and moved to a new location in the axilla (armpit). Dr. Granzow then uses specialized microsurgical techniques to reconnect the blood vessels to new vessels in the armpit, providing vital support to the transferred lymph nodes while they heal in the new area.
The transferred lymph nodes then serve as a filter or conduit to remove the excess lymphatic fluid from the arm and return it to the body’s natural circulation.
This method of lymph node transfer can be performed together with a DIEP flap breast reconstruction. The combined procedure allows for both the simultaneous treatment of the arm and the creation of a breast in one surgery. The DIEP flap reconstruction provides the opportunity for a beautiful and natural-appearing reconstructed breast combined with contouring of the abdomen (similar to a tummy tuck). The lymph node transfer portion of the surgery removes the excess lymphatic fluid to return form, softness, and function to the arm.
The groin lymph nodes may be transferred as a group with their supporting artery and vein without the additional tissue from the abdomen for breast reconstruction as well.
LYMPHATICOVENOUS ANASTOMOSIS (LVA)
Lymphaticovenous anastomosis involves the use of superfine microsurgery to join lymphatic channels in the affected area directly to nearby veins. The lymphatics are quite small, typically approximately 0.1 mm to 0.3 mm in diameter. The procedure employs specialized techniques and superfine surgical sutures sewn with the aid of an adapted high power microscope.
The procedure can be an effective and long-term solution for extremities. Patients must have excess fluid in the arm or leg with pitting issues to be candidates for this procedure. After the procedure, most patients significantly decrease or eliminate the use of their compression garments. In our experience, patients have results which range from a moderate improvement in extremity circumference to an almost complete resolution of the problem.
LVA is the least invasive of the modern procedures. Patients have the option of returning home the day of their procedure.
SUCTION-ASSISTED PROTEIN LIPECTOMY (SAPL) (ALSO KNOWN AS LYMPHATIC LIPOSUCTION)
SAPL has been found to be successful in treating advanced stages of this condition. It must be emphasized that the SAPL technique is NOT the standard cosmetic liposuction technique. The procedure must be performed using specific parameters, methods, and protocols, many of which have been developed and studied by Dr. Hakan Brorson in Malmo, Sweden. Specific training in this method is required, of which Dr. Granzow has taken in Sweden with Dr. Brorson. Patients are candidates if the swelling in the limb is due to deposition of fat, protein, and fibrotic tissue with non-pitting edema.
Published studies indicate a long-term and reproducible reduction in the size of the affected arm or leg and a tremendous decrease in the rate of cellulitis or infections in the affected limb.
Important limitations of this technique currently are the requirement of lifelong compression garment and sleeve therapy after surgery at this time. For some patients, the option of additional procedures to reduce the amount of compression required after surgery may be presented.
Again, specialized training of the surgeon specifically in this technique is critical. We do not recommend liposuction of affected limbs by surgeons who have not been specifically trained in the lymphedema liposuction technique.
Dr. Granzow was asked to chair the panel on Lymphedema Surgery at the 2011 Annual Meeting of the American Society of Reconstructive Microsurgery (ASRM). This meeting is the largest annual meeting of microsurgeons in the world.