A Case Series of Lymphatic Injuries After Suction Lipectomy in Women with Lipedema

Case series Patients: Female, 55-year-old • Female, 38-year-old • Female, 62-year-old Final Diagnosis: Lymphedema Symptoms: Skin fibrosis • swelling Medication: — Clinical Procedure: Liposuction and lipofilling • suction lipectomy Specialty: Dermatology • Plastic Surgery • Surgery OBJECTIVE: Unusual clinical course BACKGROUND: Lipedema is a loose connective tissue disease characterized by disproportionate subcutaneous adipose tissue hypertrophy in the extremities. There is evidence of impaired lymphatic function in women with lipedema at all stages without signs of trophic skin changes associated with hereditary or acquired lymphedema. A modification of suction lipectomy is used to treat lipedema tissue and can reduce pain, limb size, and limb swelling and reduce the need for compression in women with lipedema. Studies have shown that modified liposuction can improve quality of life and mobility. There are no reports of lymphatic injury after suction lipectomy in patients with lipedema in PubMed indexed journals. CASE REPORTS: Three women with lipedema who had no prior venous or lymphatic disease developed new-onset symptomatic International Society of Lymphology (ISL) Stage 2 or 3 lymphedema and skin and tissue changes within 6 months to 1 year after suction lipectomy for lipedema tissue on the legs. Each of the 3 women had their surgeries performed using different suction devices and under different types of anesthesia. Two of the lymphatic injury cases had subsequent nuclear lymphoscintigrams that confirmed impaired lymphatic function. CONCLUSIONS: We report 3 cases of women with lymphatic injuries after modified suction lipectomy to treat lipedema. Clinical history, exams, and confirmatory studies support the assessment that suction lipectomy caused newly-manifested signs and symptoms of lymphedema. Further study is needed to determine the risk of permanent lymphatic injury with suction lipectomy in larger numbers of lipedema patients.