This website is dedicated to providing combined surgical and other treatment options as a long term solution for patients with lymphedema. Dr. Granzow is a pioneer in the treatment of lymphedema, and personally performs these surgeries in California in the Los Angeles area in private hospitals. He was the first to effectively combine different types of lymphedema sugery and has created the FLO System (SM) of Functional Lymphedema Operations to integrate the different surgical methods.
from the Los Angeles Times
"Breast Cancer" Supplement
Dr. Granzow at the National Lymphedema Network Conference in Dallas, Texas
Dr. Granzow reviewed current approaches to lymphedema surgery at the September, 2012 National Lymphedema Network Conference in Dallas, Texas. The 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.
Tel: (310) 882-6261
About Lymphedema Surgery
Lymphedema has different presentations which require different types of surgical and non-surgical treatment. There is no single method of treatment or surgery which is best for all types of lymphedema.
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 techniques for lymphedema treatment. He actively maintains memberships in organizations and societies which promote the safe and effective treatment of lymphedema. He not only routinely corresponds with recognized leaders in the field of lymphedema treatment in the United States and throughout the world, but also has spent time with them in their institutions learing the latest techniques and therapies.
It is critical that any surgeon chosen to perform lymphedema 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.
Lymphedema Surgical Treatment Options
Multiple different and effective surgical treatments now exist for lymphedema, and each must be chosen specifically for the proper patient. Some procedures, like vascularized lymph node transfers, are relatively new. Other procedures, such as lymphaticovenous anastomoses, 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. For example, lymph node transfers, even if properly performed by a trained surgeon, carry the theoretical risk of new onset lymphedema at the donor extremity, especially if taken from the axilla (armpit) to be placed in another location of the body. Lymphedema liposuction, 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 the benefit while minimizing the risk of surgery. He works closely with trained lymphedema therapists to maximize the overall outcome.
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 mamber 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.
All types of lymphedema surgical procedures covered here are performed personally by Dr. Granzow in private hospitals employing personalized service and the highest standards of medical care.
Safety of Lymphedema Surgery
Dr. Granzow practices only the most modern surgical techniques to treat lymphedema. These modern surgeries are completely different from the previously disfiguring procedures which were performed by other doctors in the past. He has gone to great lengths to incorporate the highest levels of safety into his modern techniques. To date, none of his lymphedema surgery patients have had their lymphedema worsen from the surgery or begin at a lymph node donor site.
The FLO System of Lymphedema Surgeries
The FLO System (SM) of Functional Lymphedema Operations was created by Dr. Granzow to incorporate the different modern types of lymphedema surgeries to provide a consistent and unified treatmentregimen of procedures to best treat each patient. Currently, lymphatic liposuction may be used to treat the large amounts of accumulated solids in an arm or leg affected by lymphedema. Both vascularized lymph nodes transfers (VLNT) and lymphaticovenous anastomosis (LVA) are used to remove fluids which are present and to prevent their future reaccumulation. Each procedure is effective in different situations. Dr. Granzow will review which procedure(s) my be best suited for your individual situation. The system is a dynamic tool which will evolve and change as new technology is introduced in the future.
Vascularized lymph node transfers have been shown to be an effective method for the treatment of lymphedema 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 to provide 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 often is performed together with a DIEP flap breast reconstruction. The combined procedure allows for both the simultaneous treatment of the arm lymphedema 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 which is very 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. Patients must have excess fluid in the arm or leg with pitting lymphedema to be candidates for this procedure.
In some cases, the groin lymph nodes may be transferred as a group with their supporting artery and vein but without the additional tissue from the abdomen for breast reconstruction.
Lymphaticovenous anastomosis involves the use of supermicrosurgery 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 suture sewn with the aid of an adapted high power microscope.
The procedure can be an effective and long-term solution for extremity lymphedema. Patients must have excess fluid in the arm or leg with pitting lymphedema to be candidates for this procedure. After the procedure, most patientssignificantly 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 lymphedema procedures. Patients have the option of returning home the day of their procedure.
Lymphatic liposuction has been found to be successful in treating advanced stages of lymphedema. It must be emphasized that the lymphedema liposuction technique is NOT the standard cosmetic liposuction technique. The precodure must be performed using specific parameters, methods and protocols, many of which have been delevoped and studied by Dr. Hakan Brorson in Malmo, Sweden. Specific training in this method is required, and Dr. Granzow has taken this training 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 lymphedema 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.
Dr. Granzow on the panel on Lymphedema Surgery
Special Highlight: Dr. Granzow talks about Breast Reconstruction
On MD-VOD, Dr. John Kennedy is joined by board certified plastic surgeon, Dr. Jay Granzow to learn about breast cancer. Together they examine the cause of breast cancer, who is at risk, the symptoms, how it's diagnosed and available medications, treatments and therapies. They further discuss the consequences and the realities of living with breast cancer, including insurance coverage and related costs.
*****This video contains healthcare information only, not medical advice.*****
Host, Dr. John Kennedy, MD, FACC is the Director of Preventive Cardiology and Wellness, Marina Del Rey Hospital, Marina Del Rey, California. He is on the Board of Directors for the American Heart Association and is the Co-Author of The 15 Minute Heart Cure: The Natural Way to Release Stress and Heal Your Heart in Just Minutes a Day.
Guest expert, Dr. Jay Granzow is an internationally recognized plastic surgeon particularly known for his expertise in Breast Cancer Reconstruction and Lymphedema surgery. He is certified by both the American Board of Plastic Surgery and the American Board of Otolaryngology. He completed his B.S.E. in chemical engineering with honors at Princeton University, and received his M.D. from Tulane Medical School. As a leading expert in Breast Cancer Reconstruction and Lymphedema Surgery, he frequently lectures on these subjects at major scientific and medical conferences.