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Suction-Assisted Protein Lipectomy (SAPL)



Patients whose lymphedema has progressed to the point that their limbs no longer adequately respond to conservative or lymphatic compression therapy may be candidates for liposuction which is specially adapted to treat this advanced condition. The liposuction technique is different from the normal cosmetic liposuction methods and has been pioneered by Dr. Hakan Brorson in Malmo, Sweden.

Before Lymphatic Liposuction

After Lymphatic Liposuction
Patient with a prior 17-year history of non-pitting lymphedema of the right arm, treated with specialized lymphatic liposuction. After treatment, the affected right arm is now slightly smaller than the unaffected left side.

Patients who have lymphedema swelling in the arm or leg that is not fluid-filled and has non-pitting edema may be good candidates. This occurs when the lymphedema fluid has been replaced by fat and protein and can no longer be drained by techniques such as lymph node transfer or lymphaticovenous anastomoses. In many cases the affected extremity may feel soft, and a careful examination by a trained expert may be required to differentiate soft solid from soft fluid in an arm or leg.

It is critical to note that this technique is different from normal liposuction techniques, and this technique should not be performed by surgeons who are not specifically trained in this specialized type of liposuction. A team approach with surgeon and therapist is required for best results.

Dr. Granzow has trained with Dr. Hakan Brorson in Sweden in this method of lymphedema treatment and lead one of three teams in the United States qualified to perform this type of procedure.

Dr. Granzow in surgery with Dr. Hakan Brorson in Malmo, Sweden


This specialized liposuction has been shown to be effective in reducing the size and firmness of the affected arm or leg. Our results are consistent with those in the published literature.

Mean postoperative excess volume reduction in 95 women with arm lymphedema following breast cancer, from Brorson, The Facts About Liposuction As A Treatment For Lymphoedema, Journal of Lymphoedema, 2008

However, patients must follow lifelong use of compression garments after this type of surgery to prevent recurrence of the lymphedema and soft tissue swelling at this time. Carefully performed studies have shown that lack of continued compression can allow relapse of the edema swelling in the affected extremity.
The possibility now exists to reduce the need for postoperative compression garment use through a combination of lymphedema procedures. Dr. Granzow was the first surgeon to successfully combine Suction-Assisted Protein Lipectomy (SAPL) with a subsequent Vascularized Lymph Node Transfer (vLNT) in the same patient to reduce the requirement for postoperative sleeve use. The results were presented at the National Lymphedema Network Conference in Dallas, Texas in September 2012.

Patient Before Lymphedema Surgeries

Patient After Lymphedema Surgeries
Patient 18 Months After Lymphatic Liposuction and 7 Months After Vascularized Lymph Node Transfer. A volume reduction of over 80% was achieved and a compression garment is no longer worn during the day.


Studies in the medical literature have shown that lymphatic liposuction has been shown to significantly decrease the incidence of surgical infections and cellulitis after surgery. Studies also have shown that this specialized type of lymphatic liposuction does not appear to further damage the already damaged lymphatics in an arm or leg affected by lymphedema.