Facts About Lymphedema
Lymphedema is characterized by the excess accumulation of fluid, fat and protein in an area of the body. Most commonly, lymphedema can occur after the treatment of cancer of the breast or other areas with surgery and / or radiation therapy. In some cases, the condition may be congenital, or occur spontaneously. Lymphedema has different presentations which require different types of surgical and non-surgical treatment. There is no single method of treatment which will address all types of lymphedema.
Conservative therapy has been the mainstay of lymphedema treatment. All patients with lymphedema should be seen by a therapist specifically trained and experienced in lymphedema therapy.
Microsurgery is used by specialized surgeons to manipulate tiny blood and lymphatic vessels. Few plastic surgeons routinely perform advanced microsurgery, and only a small handful have been trained to treat lymphedema.
Three modern surgical methods exist to effectively treat lymphedema. These include Vascularized Lymph Node Transfer (VLNT), lymphaticovenous anastomosis (LVA) and specialized Lymphatic Liposuction. Dr. Granzow is the only surgeon in the world trained in all three of these methods. It is important to note that these surgical procedures are not related to the previously ineffective lymphatic debulking procedures of the past.
In lymphedema-affected extremities which are early in their presentation and still contain significant amounts of fluid, drainage can be accomplished by means of VLNT and LVA. In more advanced cases of lymphedema, lymphatic fluid has been replaced by fat and protein. These limbs respond poorly to conservative compression therapy and may be soft from fat or firm from protein and fibrosis. Lymphatic Liposuction is the best method used to such cases.
During your consultation, Dr. Granzow will help you determine which type of edema is present and which procedure will offer the most long-term benefit.
Vascularized Lymph Node Transfer (VLNT):
Vascularized Lymph Node Transfer replaces the nodes lost through surgery and/or radiation with healthy, functioning lymph nodes takes from elsewhere in the body. Dr. Corinne Becker from Paris, France, initially pioneered this type of procedure. Lymph nodes are usually taken from the groin area with their supporting blood vessels and moved to a new location in the axilla (armpit). Using microsurgical techniques, the blood vessels are reconnected to vessels in the chest or armpit to support the transferred lymph nodes while they heal in the new area.
Most often, this method of lymph node transfer is performed together with a DIEP flap breast reconstruction. In some cases, the lymph nodes alone, without breast reconstruction, may be transferred and reconnected for improved drainage. This technique functions best when a patient’s arm is still soft and compressible with lymphatic fluid.
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Dr. Granzow in the operating room with Dr. Corinne Becker in Paris, France |
Lymphaticovenous Anastomosis (LVA):
Lymphaticovenous anastomosis is a method of directly connecting the lymphatic vessels in the affected area of the body to the tiny veins nearby. This allows the backed-up lymphatic fluid to drain directly into the vein and be returned to the body’s natural circulation. The goal of the procedure is to reduce extremity swelling, pain and discomfort and decrease or eliminate the need for further use of compression garments. In our experience, most patients have results which range from a moderate to a significant improvement of their extremity swelling. To be a candidate for this procedure the patient’s edema must be soft and compressible. If the edema is firm and fibrotic the patient is more likely to be a candidate for lymphatic liposuction.
Dr.Jay Granzow and Dr. Isao Koshima performing lymphaticovenous anastomoses in Japan in 2005
Lymphatic Liposuction:
The liposuction for lymphedema technique is different from the normal cosmetic liposuction and has been pioneered by Dr. Hakan Brorson in Malmo, Sweden. This procedure will reduce the size of the affected arm or leg to approximate the normal, unaffected side. The technique also has been proven to decrease the incidence of cellulitis in the affected limb.
Dr. Granzow has trained with Dr. Brorson and leads one of three teams located in the United States. This technique should not be performed by surgeons who are not specifically trained in this specialized type of liposuction. A team approach between surgeon and lymphedema therapist is required.
Patients are candidates for this procedure have advanced disease where the lymphatic fluid in the affected limb has been replaced by fat and protein. At this point the limb will no longer respond well to conservative treatment including the use of lymphatic compressive therapy. The skin of patient’s affected limb will leave only a small impression when prolonged pressure is exerted in the location of the edema.
Patients must continue to follow lifelong use of compression garments after this procedure to prevent recurrence. Studies have shown that lymphatic liposuction does not appear to further damage the already damaged lymphatics.
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Dr. Granzow in surgery with Dr. Hakan Brorson in Malmo, Sweden |
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