The gold standard for lymphedema treatment is Complex Decongestive Therapy (CDT), a combination of conservative (non-surgical) therapies, such as Manual Lymphatic Drainage (MLD) or compression therapy.
Surgical therapies can be an option when conservative treatment is not sufficient to treat your lymphedema. Usually, CDT is continued for at least 6 months.
Surgery may also be necessary in the following cases:
- Severe swelling and deformities
- Excessive soft tissue after successful decongestion therapy
- No response to compression therapy
- Recurrent cases of bacterial cellulitis
- Lymphedema at the eyelid or genitals
- Long-term complications, such as lymphangiosarcoma
- Connections between the lymphatic system and the skin (lymphocutaneous fistula).
What are the types of lymphedema surgery?
Depending on the reason for surgical therapy, there are different types of lymphedema surgery:
- Microsurgery to reconstruct the lymphatic system
- Surgical reduction to remove excessive tissue (debulking)
- Liposuction to remove the fatty tissue and to improve the limb shape and size.
There are different types of microsurgery, but all aim to reconstruct the lymphatic system. Before microsurgery, the function of your lymphatic system has to be visualized. For this purpose, a small amount of fluorescent dye is injected into your lymph vessels. The lymph flow transports the dye and gives a picture of your lymphatic system and its function. Here is a brief description of how microsurgery can reconstruct the lymphatic system:
Lymph vessel transplantation: Well-working lymph vessels from your body are transplanted to the area with non-working or missing lymph vessels.
Lymph node transplantation: Well-working lymph nodes from your body are transplanted to the area with non-working or missing lymph nodes, together with their surrounding tissue.
Interposition of veins: A vein of your body is used to build a bridge between your lymph collectors to improve Lymphatic Drainage. This technique can be used to restore the lymph passage when the lymphatic flow is blocked.
Lymphatic-venous and lymphonodulo-venous anastomosis: Anastomosis is the medical term for a connection between two structures. Surgeons create a local connection between the lymph vessels and a vein (lymphatic-venous anastomosis) or a lymph node and a vein (lymphonodulo-venous anastomosis). The technique aims to improve the drainage of the lymphatic flow.
Surgical reduction may be necessary after successful decongestion therapy to remove excessive tissue and improve the limb's shape. It is also an option for patients with lymphedema at the eyelid or external genitals or to reduce the symptoms of severe lymphedema.
Liposuction for lymphedema patients aims to remove the fatty tissue and to improve the limb shape and size. It does not treat your lymphedema itself and does not improve Lymphatic Drainage. Liposuction usually requires general anesthesia, and you will probably spend a few days in the hospital. Compression therapy is an essential part before and after liposuction to ensure the therapy's long-term success.
Secondary lymphedema can develop from overweight, and overweight can also impair existing lymphedema. Bariatric surgery may be an option for certain patients with difficulties losing weight.
What are the risks of lymphedema surgery?
The different surgical options all have their risks. Some general risks can occur after all types of lymphedema surgeries, such as infections, bleeding, or damage to the nerves and vessels during surgery. Lymphedema surgeries are not suitable for every lymphedema patient. If you want to know more about surgical treatments for lymphedema, a discussion with your healthcare professional (HCP) is recommended.
Always discuss with your HCP first if surgery is an option and beneficial for you. Whether your health insurance covers the costs of a surgery may differ, but you can discuss this with your HCP and/or your health insurance.
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