For some patients, trying to manage their lymphoedema by directly operating on their lymphatic drainage system or lymph nodes is not possible. It may be that the lymphatic vessels are so badly damaged as a result of long-term lymphoedema that very little lymph fluid is flowing within them. In some patients, the entire lymphatic system is poorly developed, as is found in primary lymphoedema. In these cases, it makes very little sense to re-route the lymphatics or transfer lymph nodes. Finally, It may be that the volume of the limb is so big, that that lymphovenous anastomosis (LVA) or lymph node transfer (LNT) alone, will not make enough difference to the limb size by itself.
In these cases, lymphoedema liposuction may be the answer. This specialist liposuction service removes large volumes of fat below the skin, reducing the size of the leg or arm dramatically. By doing this surgery, Mr Ghattaura aims to give you a leg/arm comparable in size to your normal limb. Most of his patients also describe a significant reduction in heaviness and pain of their limb after this surgery and are now able to wear normal clothing.
The ideal patients for this surgery have a large leg or arm due to lymphoedema with a soft feel and good skin quality. Generally, the patients selected for liposuction are unresponsive or not suitable for LVA or LNT. In addition, you must have a BMI below 35 and have no significant medical problems. Mr Ghattaura uses the Bodyjeyt system for his lymphoedema liposuction – a device that gently removes fat from the leg or arm using a spray of water to break up the fat. The benefit of Bodyjet liposuction is reduced bruising after surgery, reduced pain and less damage to nearby structures.
Mr Ghattaura has extensive experience of this highly specialised procedure and offers this surgery routinely on the NHS and also privately. He works extremely closely with his lymphoedema therapy colleagues, understanding the need for joint care though this complex surgery.
What’s involved in the procedure?
Mr Ghattaura will first carefully assess you in his Lymphoedema clinic with his lymphoedema therapists, to assess the quality of your skin and fat. The therapy team will then measure you for your post-surgery garments and prepare you for surgery. You will also need to wear specialised bandages on your legs or arms before your surgery to make sure as much of the excess lymph fluid has been removed as possible before the day of surgery.
On the day of surgery, Mr Ghattaura will remove your garments and his anaesthetist will prepare you for theatre with a pre-med. The surgery lasts between 3-4hrs and is performed under general anaesthetic (with you asleep). Mr Ghattaura will also arrange for you to have a urinary catheter whilst you are asleep, so his team can continually measure your body fluid volumes during and after surgery.
Mr Ghattaura will then use the Bodyjet liposuction system to carefully remove fat, protecting your vital structures (nerves, blood vessels) as well as your skin. The liposuction tubes are passed into the fat of you leg or arm via multiple, very small keyhole incisions. At the end of surgery, these incisions are closed using dissolvable stitches and small dressings are applied. Mr Ghattaura will then apply compression garments to your limbs and send you back to the ward when you are pain-free. Mr Ghattaura insists that you are very carefully monitored for the next 24hrs after surgery, checking for any bleeding into your limbs and any blood pressure or pulse changes. Mr Ghattaura will then personally take your dressings down the following morning to check your skin is intact and then reapply the same garments. After this, you will be encouraged to walk with the physiotherapists along the hospital corridor and up and down the stairs, to make sure you are safe to go home. You should expect to stay in hospital for 2 days before you are discharged.
The recovery for this surgery is quite long and you will need to prepare for this, physically and mentally. You’ll need lots of support from your friends and family in the first few weeks after surgery. You should expect swelling, bruising and some pain for the first 6 weeks after surgery. Most people plan a restful first week and then start moving more in the second week. You will most likely need 4-6 weeks off light work and 6-12 week off more physical activities like the gym. Mr Ghattaura will also prescribe you specialised pain killers for the first 2-4 weeks after surgery and blood thinning injections for 6 weeks. The swelling normally takes 3-months to subside and you will need to wait this long before seeing your final limb size. During this time, Mr Ghattaura and his team will keep in regular contact with you to assess your progress and provide you with necessary advise.
Liposuction is an excellent choice of surgery, if you have an enlarged, soft limbs due to lymphoedema and are unsuitable for microsurgical interventions (LVA or LNT). Mr Ghattaura’s patients report high levels of satisfaction after this surgery, as their limbs dramatically decrease in size and they can start to wear normal clothing. It is important to remember, that this is not your normal cosmetic liposuction as the volumes removed are much larger and the specialised methods of fat removal are also very different. In addition, since the underlying lymphatic vessels or lymph nodes have not been treated, you still need to wear garments for life after this surgery.