Lymphoedema is a condition characterised by chronic swelling. The swelling is caused by an accumulation of protein-rich fluid in the tissue of the affected body part, most commonly in the arm or leg.

Lymphoedema is typically managed conservatively using a combination of compression bandaging/garments, skin care, exercise and massage. There is no cure for lymphoedema but a small subset of patients can have surgery to improve their symptoms or function.

Below are some surgical options for lymphoedema. The type of surgery you require will depend on your lymphoedema presentation.

• Liposuction surgery: This type of surgery uses a vacuum-assisted cannula placed repeatedly at different sites under the skin of the swollen limb, to remove fat and reshape the limb.
• Lympho-venous anastomosis: Microsurgery is used to connect a very fine lymph vessel to a small vein to divert the lymph flow back into the circulation. Several cuts may be made along the limb to re-establish lymph flow.
• Vascularised Lymph Node Transfer: This is a type of reconstructive surgery where a tissue flap containing lymph nodes and suitable blood vessels is harvested from a healthy area elsewhere in the body and connected to the blood vessels in area of the lymph node dysfunction e.g. armpit or groin in order to bring vascularised lymph nodes into an area with the aim of promoting lymphatic sprouting and repair.

Lymphoedema surgery is not suitable for everyone. Surgery type is dependent on your lymphoedema presentation and your goals after surgery.

• Liposuction surgery is suitable if you have had lymphoedema for a long time and there are fatty changes under your skin. Liposuction surgery is performed usually on an arm or leg but excludes the hand and foot areas.
• Reconstructive surgeries such as lympho-venous anastomosis and vascularised lymph node transfer surgery are suitable if you have had mild or moderate lymphoedema with a predominant fluid overload and minimal fatty changes under your skin. Your surgeon will likely use special imaging with an injectable dye to see if you have any viable lymph channels under the skin that would be suitable for connection to nearby veins. Lympho-venous anastomosis and vascularised lymph node transfer surgery may occur at the same time. In select suitable cases, liposuction can be performed to remove excess fat before microsurgery, in the same operation or separately.

Yes, lymphoedema surgery often requires general anaesthesia. However, many lympho-venous anastomosis surgery can be done under local anaesthesia.

Surgery is not a cure for lymphoedema. Surgical risks include bleeding, infection/cellulitis, poor healing, and damage to nerves. There are also risks and complications associated with general anaesthesia.

There are varying reports of success rates with reconstructive surgeries for lymphoedema. You will need to discuss your individual case with your surgeon and weigh up the risk versus benefit.

Surgery can be performed in either a day-procedure clinic or a hospital, depending on your general health and the extent of the procedure. A short hospital stay may be required in some instances. Your Specialist Plastic Surgeon will advise on the best option for you.

You may need to have some diagnostic tests and scans performed prior to surgery to ensure you are a suitable candidate for the type of lymphoedema surgery selected. You should have a thorough discussion with your surgeon about the need for post-operative compression garment use and recovery time prior to the surgery.

It is important to minimise your swelling as much as possible prior to surgery. A course of compression bandaging or other lymphoedema treatment may be recommended prior to surgery.

Your surgeon will also advise you if any other tests are required, such as blood tests, X-ray examinations or an Electrocardiograph (ECG) to assess your heart.

Prepare a “recovery area” in your home. This may include pillows, ice packs, a thermometer and a telephone within easy reach. Make sure you arrange for a relative or friend to drive you to and from the hospital or clinic. Someone should also stay with you for at least 24 hours after you return home.

Your surgeon should give detailed preoperative instructions. Follow them carefully.

You will need to ensure you take your prescribed antibiotics (for around 2 weeks) to avoid an infection. Your surgeon will inform you of their protocol for resumption of activity, elevation and compression garment use after surgery. The protocol differs depending on your type of surgery, surgeon and treatment centre.

As with any surgery, there will be skin disruption where surgery has taken place. Your surgeon will be able to advise you on the methods to minimise scarring.

Some Lymphoedema surgical procedures may be partially covered by your private health insurer depending on your level of cover. You will also need to factor in costs of compression garments (which can be expensive) and conservative lymphoedema management prior to, and following the surgery.

Lymphoedema:
A protein-rich swelling that can affect any body part that most commonly occurs after cancer surgery to remove the lymph nodes.

Lymph nodes:
Lymph nodes (or lymph glands) are small lumps of tissue that contain white blood cells which help our body fights infection. They are found commonly in our armpits, groin, pelvis, neck and in the centre of our chest.

Lymph vessels:
These are channels that connect our lymph nodes to our body tissues.

Compression garments:
These are pieces of tight elastic clothing that fit around a swollen body part to minimise and maintain limb shape. It may be in the form of a stocking for leg swelling or an arm sleeve and glove for arm/hand swelling.