LYMPHEDEMA

DEPARTMENT OF PLASTIC AND RECONSTRUCTIVE SURGERY

MALMÖ UNIVERSITY HOSPITAL

S-205 02 MALMÖ

Head: Professor Henry Svensson, M.D., Ph.D.

Lymphedema Unit: Håkan Brorson, M.D., Ph.D.

Telephone: +46 40 33 10 00 Fax: +46 40 33 62 71

e-mail: brorson@plasticsurg.nu





A new method for treatment of chronic lymphedema of the arm after a radical mastectomy.

Lymph is produced as the result of hydrostatic filtration of blood in the smaller blood vessels. Normally lymph is removed from the extracellular space via small lymph vessels and is then carried to the lymph glands. From these glands the lymph finally empties into the blood stream.

At the time of a radical mastectomy, the axillary lymph glands are removed to prevent any spread of the cancer. Many of these patients develop lymphedema of the arm due to the impaired lymph drainage, which is further exacerbated by post-operative irradiation. The accumulating lymph and the thickened subcutaneous fat leads to chronic lymphedema. After some time subcutaneous fibrosis can develop. Common symptoms of chronic lymphedema are pain, a feeling of heaviness and decreased mobility of the arm.

Conservative therapies (manual lymph therapy according to Foldi, compression garments), if used early, can remove the edema, but in long-standing cases this is not always possible. To date there has not been a surgical procedure that completely removes the edema after breast cancer treatment. At the Department of Plastic and Reconstructive Surgery, Malmˆ University Hospital, Malmˆ, Sweden, a new and unique method of complete removal of cronic lymphedema has been developed using a special liposuction technique. The edema and the increased subcutaneous fat are removed via some 30 small incisions along the arm. This results in disappearance of pain and feeling of heaviness as well as an increased mobility of the arm.

A prerequisite to the success after the operation is a vigilant use of a custom-made compression garment. This garment has to be used at all time or lymphedema inevitably recurs.

We have operated on 85 patients to date using this technique. The mean volume of the lymphoedema was 1.9 liters. The edema reduction is complete, and no recurrence of the edema has been seen at 10 years follow-up.


References:

Brorson H, Svensson H. Complete reduction of lymphoedema of the arm by liposuction after breast cancer. Scand J Plast Rec Surg Hand Surg 1997; 31: 137-143.
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Brorson H, Svensson H. Skin blood flow of the lymphedematous arm before and after liposuction. Lymphology 1997; 30: 165-172.
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Brorson H, Svensson H. Liposuction reduces arm lymphedema without significantly altering the already impaired lymph transport. Lymphology 1998; 31:156-172.
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Brorson H, Svensson H. Liposuction combined with controlled compression therapy reduces arm lymphedema significantly better than controlled compression therapy alone. Plast Reconstr Surg 1998; 102: 1058-1067.
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Thesis: Brorson, H. Liposuction and controlled compression therapy in the treatment of arm lymphedema following breast cancer
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Brorson H. Liposuction gives complete reduction of chronic large arm lymphedema after breast cancer. Acta Oncologica 2000; 39: 407-420.
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Brorson H. Fettabsaugung des Lymphödems am Arm. Handchir Mikrochir Plast Chir 2003; 35: 225-232.
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Chronic disabling lymphedema (3.1 litres) since 15 years in the left arm.



Result one year after operation. The arms are equal.






Chronic disabling lymphedema (2.1 litres) since 8 years in the right arm.



Result 3 years after operation. The arms are equal.




Contact the lymphedema team:





From left to right: Gaby Olsson, Håkan Brorson, Karin Ohlin


Håkan Brorson, Consultant, M.D., Ph.D.

Plastic and Orthopaedic Surgeon

Member of:
The Lymphoedema Study Group
The Swedish Medical Association
The Swedish Society of Medicine
The Swedish Society of Oncology
The International Society of Lymphology
The Swedish Association of Plastic Surgeons
The European Association of Plastic Surgeons
The Swedish Association of Orthopedic Surgeons
The Scandinavian Association of Plastic Surgery
The Swedish Association of Aesthetic Plastic Surgeons
The International Confederation for Plastic, Reconstructive and Aesthetic Surgery

National Delegate of the European Association of Plastic Surgeons
Vice president of the National Planning Group for Lymphedema
Scientific Secretary in Swedish Association of Plastic Surgeons
Council member of the Swedish Society of Lymphology
Member of the Editorial Board, Lymphology





Karin Ohlin

Occupational therapist (OTR)


Gaby Olsson

Physiotherapist (RPT)



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Out-patient clinic: Tuesdays: 9.00 AM - 3.00 PM


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