Liposuction for Lipoedema

Updated information relating to the recent NICE guidelines can be found here.

What is liposuction in relation to lipoedema?

Lipoedema is a fat tissue disorder. It is a genuine medical condition characterised by an accumulation of painful fat below the waist, resulting in hips, buttocks and legs that are out of proportion with the upper body. It can also affect the arms, resulting in laxity of skin with abnormal fat pads at the elbow and wrist. It typically affects women and often develops during puberty.

Over time, expanding fat cells can block the vessels of the lymphatic system, which normally helps return fluid to the blood stream. This blockage prevents the proper drainage of lymph fluid. Lipoedema is estimated to occur in 11% of the adult female population, meaning that millions of women worldwide are affected. A large number of health care professionals remain unaware of the condition and patients are simply dismissed as being overweight.

Liposuction is a surgical procedure for removing fat. In patients with lipoedema, liposuction can remove these fatty deposits permanently. If liposuction is performed then you will see an immediate reduction in the size of the limb. However some patients have a combination of lipoedema and lymphoedema and it is essential that they continue to wear compression garments, as the limb will swell again if the compression is not maintained. For patients who do not have lymphoedema, compression garments will not be required in the long term and the fat will be permanently removed. The input of a lymphoedema nurse is essential to the process.

What does the surgery involve?

Suction-assisted liposuction involves the use of a cannula (a thin hollow tube) to manually loosen and remove fat to create a nicer shape and reduce the volume of the limb. The cannula is inserted through tiny incisions in the skin and suction is applied to remove fat from the body. The limb is infiltrated with large volumes of fluid (tumescence) to allow the cannula to glide through the tissue with minimal damage to blood vessels and lymphatics.

It takes three to four hours to perform liposuction depending on the size of the treatment area. The tiny incisions are closed with a small dissolvable stitch and a waterproof plaster is applied. You will need lipoedema nurse input (either with my lipoedema nurse or your local team) to ensure that the compression is maintained as the size of your limb reduces.

You will be placed in compression garments in theatre and these need to be removed for a short period every day to enable you to wash and let your skin breathe. Liposuction procedures for lipoedema are generally carried out under general anaesthetic (when you are fully asleep). However, it can also be performed under spinal block (when your legs are completely numb yet you are awake).

We often use a combination of spinal anaesthetic and general anaesthetic to make sure you are comfortable immediately after surgery. The area where the fat is removed is tender and aching. Mobilising is encouraged the next day and swelling will be marked for up to six weeks, but will gradually disappear with time. You will stay in hospital for two nights to ensure that you are comfortable, have medical care and are able to mobilise.

What are the risks and side effects of surgery?

Having lipoedema surgery can be a very positive experience. Complications are infrequent and usually minor. However, no surgery is without risk and it is important that you are given a clear picture.

Scar – scars are very small and hidden in a skin crease. They should be barely perceptible. However some people heal with thick scars and this can make them more noticeable.

Bruising and swelling – this happens in every patient and will be marked. Swelling persists for 6 weeks to 6 months but will be improving constantly. Bruising resolves in weeks.

Blood loss – patients with lipoedema have leaky blood vessels, varicose veins and sometimes anaemia before surgery. It is therefore more likely to bleed and bruise than a liposuction in a patient without lipoedema. There is a risk of needing a blood transfusion after surgery, although this is fairly low. Lipoedema patients are prescribed iron tablets (330mg of ferrous gluconate three times a day) for 4 weeks before and after surgery to help build up and replenish iron stores.

Infection – although not common, infection from any surgical procedure is possible. You will be given a course of antibiotics to cover you during the healing process.

Contour irregularities and loose skin – it is possible to have indentations and loose skin following this procedure. Skin will contract to some degree, but if you are left with significant laxity you may require a thigh or arm lift.

Wound healing problems – blisters or even skin necrosis can occur following liposuction. This is rare and should settle with dressings. However, significant skin necrosis may even need a small split skin graft. This is very unlikely.

Altered sensation – numbness, pins and needles or burning often occur as nerves recover. This should resolve over the course of a few weeks to months.

DVT/PE/fat embolus – following any surgical procedure it is possible to develop a blood clot in your legs, which could potentially break off and move to your lungs. If the blood clot is large enough it could prove fatal. In order to reduce any risks of this we give you special stockings to wear in bed and a blood thinning injection if you are not mobile.

Further liposuction may be necessary to give the desired result. Only a certain amount of fat can be removed during one operation (between 4-12 litres). The removal of more than this in one session can put you at risk of fluid shifts and blood loss. If you desire more liposuction then multiple procedures can be necessary.

All the risks will be discussed in detail at your consultation. However, if you have further questions or concerns, do not hesitate to discuss these with your surgeon. Decisions about surgery should never be rushed.

What happens after the operation?

At the end of the procedure, a compression garment will be applied to the area to help the skin conform to the new shape and to reduce any swelling. You will be fitted for these by Julie Cunneen (Lymphoedema Clinical Lead) to ensure you have the correct amount of compression.

As long as you are feeling well after the operation, you will be able to go home 2 days later. You will not be able to drive yourself home from hospital and ideally, you should have someone to stay with you for a few days to lend a hand.

Before you leave the hospital, a follow up appointment will be booked with the nurse for 1 week and an appointment with me for 6-12 weeks or sooner should you have any problems.

What is the estimated time for recovery, absence from work and return to usual activities?

Recovery times vary from one person to another but most patients take 2 weeks off work. You can drive after 2 weeks and can return to normal activities by 4-6 weeks. If you have any concerns during this period, do contact the hospital, Julie Cunneen or myself for advice.