Lymphoedema
Fluid circulation via the bloodstream is familiar to most people. From the heart, blood flows out through the arteries, and back through the veins. Less familiar is an additional system called “lymphatics”, which drain excess tissue fluid (“lymph”) through immune system filters (“lymph nodes”) and back towards the heart.
Lymphoedema is a limb condition characterized by swelling, pain and vulnerability to infection. It is caused by body fluid collecting and stagnating in body tissues, as a result of blocked or non-functioning lymphatics. While some people are born with faulty lymphatics (“primary lymphoedema”), most lymphoedema is the result of disease affecting previously normal lymphatics (“secondary lymphoedema”). In New Zealand, the most common reasons are cancer treatment, trauma, and infection. In some overseas countries, parasite disease is a common cause.
Cancer survivors, particularly those who have had lymph node treatment for breast, gynaecologic, urological or skin cancer, may develop lymphoedema even if the cancer has been defeated. This can significantly impact their daily lives and serve as a constant reminder of their battle with the disease.
Symptoms, which may manifest months or even years after initial injury, typically worsen over time. These include:
Non-surgical treatments include compression stockings, massage, physical therapy, and skin care. While these can help with symptoms, and slow or prevent worsening, they cannot cure the condition and are effective only as a lifelong change in a patient’s lifestyle.
Lymphoedema surgery has progressed significantly in the 21st century. Previously, only severe disabling lymphoedema justified the available extreme and disfiguring surgery. For those with early secondary lymphoedema, soon after their cancer treatment, operations such as Lymphaticovenous Anastamosis (LVA) and Vascularised Lymph Node Transfer can give significant and permanent benefit, although cure and independence from compression garments remains elusive. These operations leverage advances in microsurgery to create new pathways for fluid flow, bypassing obstructed lymphatics. For those at a more advanced stage, good benefits can be achieved through limb reduction via high volume liposuction, with the same provisos.
Lymphoedema is a multifaceted condition, necessitating personalized treatment plans tailored to each patient’s clinical stage and anatomical considerations. Candidates for surgery must have maximized non-surgical therapies and proven their compliance: surgery alone is doomed to fail, and must be part of a complete approach to treatment. It is essential that prospective surgical candidates have realistic expectations regarding outcomes.
During the consultation, patients should anticipate discussing their surgical goals, medical history, current medications, and previous surgeries. Plastic surgeons will evaluate their general health status, assess extremity condition, and provide recommendations based on individual needs and preferences. For those in whom microsurgery is being considered, additional imaging tests such as ultrasound and lymphatic dye mapping with a near-infrared camera are critical in deciding what options are available.
Patients are encouraged to ask questions and openly discuss their concerns with their surgeon to ensure a comprehensive understanding of their condition and treatment options. Feeling some level of anxiety is natural, and patients should feel comfortable expressing their emotions during the consultation process.
Are you vocationally registered with the Medical Council of New Zealand as a specialist plastic surgeon?
Are you a member of the New Zealand Association of Plastic Surgeons?
Will the procedure be conducted in a hospital or office-based setting, and is the facility accredited for this type of surgery?
What type of anaesthesia is needed for this procedure?
Based on my medical history and condition, is surgery the best option for me? If so, am I a suitable candidate for this surgery?
Which surgical technique do you recommend for my case, and why?
What are the realistic expectations for the outcome of this procedure in my case?
What steps or lifestyle changes are necessary for me to get the best result from my surgery?
What is the anticipated duration of recovery, and what assistance will I need during this period?
What potential risks and complications are associated with this procedure? How would you manage these should they arise?
How will my results change over time?
If I’m unhappy with the outcome, what recourse options are available?
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Disclaimer: This website is intended to provide you with general information only. This information is not a substitute for advice from your Specialist Plastic Surgeon and does not contain all the known facts about this procedure or every possible side effect of surgery. It is important that you speak to your surgeon before deciding to undergo surgery. If you are not sure about the benefits, risks and limitations of treatment, or anything else relating to your procedure, ask your surgeon to explain. Patient information provided as part of this website is evidence-based, and sourced from a range of reputable information providers including the American Society of Plastic Surgeons, Better Health Channel and Mi-tec medical publishing.
Sarah Gardiner
Jesse Kenton Smith
Brandon Adams
