Download PDF
Phlebologie 2015; 44(03): 121-132
DOI: 10.12687/phleb2265-3-2015
Focus Lymphology – Original article
Schattauer GmbH

Treatment of lipoedema using liposuction

Results of our own surveys Article in several languages: English | deutsch
S. Rapprich
1   Dermatology Bad Soden, Bad Soden am Taunus/Germany
,
S. Baum
2   Dematological practiseim Vorderen Westen, Kassel/Germany
,
I. Kaak
3   General Medicine Westerrönfeld/Germany
,
T. Kottmann
4   Medical Statistics Hamm/Germany
,
M. Podda
5   Dermatology Department, Darmstadt Hospital/Germany
› Author Affiliations
Further Information

Publication History

Received: 07 March 2015

Accepted: 05 May 2015

Publication Date:
05 January 2018 (online)

Also available at
    Permissions and Reprints

Summary

Background: Lipedema is a painful, genetically induced, abnormal deposition of subcutaneous fat in the extremities of women. The pathogenesis is unknown. Also unknown is the number of women affected in Germany. This study presents the epidemiology of the disease. There are currently two treatment options available: Complex physical decongestive therapy and liposuction. Liposuction is the only method that removes fat permanently. An additional study proves its effectiveness and highlights its vital role as part of a comprehensive treatment concept.

Patients and methods: As part of the epidemiological research, all patients of a general practioner were examined for leg problems. The liposuction study included the preand postoperative examination of 85 patients, which was carried out using a questionnaire.

Results: Lipedema were diagnosed in 5 % of all patients of the GP practice. In all 85 patients liposuction significantly reduced pain, bruising and the tendency of swelling in the extremities. It therefore led to a significant improvement in the quality of life of the patients.

Conclusion: Lipedema is a relatively common disorder among women. Liposuction forms part of an effective treatment plan, when it is used in conjunction with pre- and postoperative complex physical decongestive therapy, a sports program, treatment of concomitant obesity, as well as psychological support, if needed. Therefore a comprehensive treatment plan should be aimed at for a succesful result.

Keywords

Lipedema - liposuction - lipolymphedema - life quality - decongestive lymphatic therapy - sports - epidemiology
 

  • References

  • 1 Allen EV, Hines EA. Lipedema of the legs: A syndrome characterized by fat legs and orthostatic edema. Proceedings of the staff meetings 1940; 15: 184-187.
    Google Scholar
  • 2 Meier-Vollrath I, Schneider W, Schmeller W. Lipödem: Verbesserte Lebensqualität durch Therapiekombinationen. Deutsches Ärzteblatt 2005; 102 (Suppl. 15) 1061-1067.
    Google Scholar
  • 3 Schmeller W, Hueppe M, Meier-Vollrath I. Tumes-cent liposuction in lipoedema yields good long-term results. Br J Dermatol 2012; 166 (Suppl. 01) 161-168.
    CrossrefPubMedGoogle Scholar
  • 4 Rapprich S, Dingler A, Podda M. Liposuction is an effective treatment for lipedema-results of a study with 25 patients. J Dtsch Dermatol Ges 2011; 9 (Suppl. 01) 33-40.
    PubMedGoogle Scholar
  • 5 Cornely M. Update Lipödem 2014: Kölner Lipödemstudie. LymphForsch 2014; 18 (Suppl. 02) 66-71.
    Google Scholar
  • 6 Fife CE, Maus EA, Carter MJ. Lipedema: a frequently misdiagnosed and misunderstood fatty deposition syndrome. Adv Skin Wound Care 2010; Feb; 23 (Suppl. 02) 81-92 quiz 3–4.
    CrossrefPubMedGoogle Scholar
  • 7 Hines Jr EA. Lipedema and physiologic edema. Proceedings of the staff meetings 1952; Jan 2 27 (Suppl. 01) 7-9.
    PubMedGoogle Scholar
  • 8 Priesmeier H, Strossenreuther RH. [Lymphedema – differential diagnoses]. MMW 2004; 146 3–4 27-28.
    Google Scholar
  • 9 Herpertz U. Die häufigsten Beinödeme. Differenzierung zwischen Phlebödem, Lymphödem und Lipödem. Phlebologie 2001; 30: 48-52.
    Article in Thieme ConnectGoogle Scholar
  • 10 Herpertz U. Das Lipödem und seine Kombinationen. Vasomed 1997; 9: 301-307.
    Google Scholar
  • 11 Herpertz U. Das Lipödem. Lymphologe. 2013
    PubMedGoogle Scholar
  • 12 Wienert V, Földi E, Juenger M. Guideline of the German Society of Phlebology. Phlebologie 2009; 38: 164-167.
    Article in Thieme ConnectGoogle Scholar
  • 13 Herpertz U. Das Lipödem und seine Kombinationen. Vasomed 1997; 9: 301-307.
    Google Scholar
  • 14 Cornely M. Das Lipödem an Armen und Beinen. Teil 2: Zur konservativen und operativen Therapie des Lipödemas, genannt Lipohyperplasia dolorosa. Phlebologie. 2011
    PubMedGoogle Scholar
  • 15 Herpertz U. (Hrsg.). Ödeme und Lymphdrainage. Diagnose und Therapie von Ödemkrankheiten. Stuttgart, New York: Schattauer; 2003
    Google Scholar
  • 16 Marshall M, Schwahn-Schreiber C. Prävalenz des Lipödems bei berufstätigen Frauen in Deutsch-land. Phlebologie 2011; 40: 127-134.
    Article in Thieme ConnectGoogle Scholar
  • 17 Herpertz U. Krankheitsspektrum des Lipödems an einer Lymphologischen Fachklinik. Vasomed 1997; 5: 301-307.
    Google Scholar
  • 18 Schmeller W. Lipödem – Aktuelles zu einem weitgehend unbekanntem Krankheitsbild. Akt Dermatol 2007; 33: 1-10.
    Article in Thieme ConnectGoogle Scholar
  • 19 Stutz J. Liposuction in lipoedema for prevention of joint compliations. Vasomed 2011; 23: 62-66.
    Google Scholar
  • 20 Wold LE, Hines Jr EA, Allen EV. Lipedema of the legs; a syndrome characterized by fat legs and edema. Annals of internal medicine. 1951; May; 34 (Suppl. 05) 1243-1250.
    CrossrefPubMedGoogle Scholar
  • 21 Flaggl F. [Psychosocial aspects of lymphedema]. Wien Med Wochenschr 2013; 163 7–8 184-186.
    CrossrefPubMedGoogle Scholar
  • 22 Child AH, Gordon KD, Sharpe P. et al. Lipedema: an inherited condition. Am J Med Genet A 2010; Apr; 152A (Suppl. 04) 970-976.
    CrossrefPubMedGoogle Scholar
  • 23 Brenner E. Das Lymphödem im Ultraschall. Lymph Forsch; 2005
    Google Scholar
  • 24 Brenner E. Fallbericht primäres Lymphödem, Histologische Befunde. Lymph Forsch; 2006
    Google Scholar
  • 25 Brenner E. Plasma-interstitielle Flüssigkeit. Lymph Forsch; 2009
    Google Scholar
  • 26 Weissleder H, Brauer JW, Schuchhardt C, Herpertz U. [Value of functional lymphoscintigraphy and indirect lymphangiography in lipedema syndrome]. Zeitschrift fur Lymphologie 1995; Dec 19 (Suppl. 02) 38-41.
    Google Scholar
  • 27 Bilancini S, Lucchi M, Tucci S, Eleuteri P. Functional lymphatic alterations in patients suffering from lipedema. Angiology 1995; 46 (Suppl. 04) 333-339.
    CrossrefPubMedGoogle Scholar
  • 28 Amann-Vesti BR, Franzeck UK, Bollinger A. Microlymphatic aneurysms in patients with lipedema. Lymphology 2001; Dec 34 (Suppl. 04) 170-175.
    PubMedGoogle Scholar
  • 29 Dimakakos PB, Stefanopoulos T, Antoniades P. et al. MRI and ultrasonographic findings in the investigation of lymphedema and lipedema. International surgery 1997; Oct-Dec 82 (Suppl. 04) 411-416.
    PubMedGoogle Scholar
  • 30 Schmeller W. Lipödem – Aktuelles zu einem weitgehend unbekanntem Krankheitsbild. Akt Dermatol 2007; 33: 1-10.
    Article in Thieme ConnectGoogle Scholar
  • 31 Wienert V, Leeman S. [Lipedema]. Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete 1991; Aug 42 (Suppl. 08) 484-486.
    PubMedGoogle Scholar
  • 32 Marshall M, Schwahn-Schreiber C. Lymph-, Lipund Phlebödem. Differentialdiagnostische Abklä-rung mittels hochauflösender Duplexsonographie. Lymphedema, lipedema and venous edema. Differential diagnostic clarification using high-resolution duplex sonography. Gefässchirurgie. 2008 13(3).
    PubMedGoogle Scholar
  • 33 Naouri M, Samimi M, Atlan M. et al. High-resolution cutaneous ultrasonography to differentiate lipoedema from lymphoedema. Br J Dermatol 2010; Aug 163 (Suppl. 02) 296-301.
    CrossrefPubMedGoogle Scholar
  • 34 Breu F, Marshall M. Neue Ergebnisse der duplex-sonographischen Diagnostik des Lip- und Lymphödems. Phlebologie 2000; 29: 124-128.
    Article in Thieme ConnectGoogle Scholar
  • 35 Monnin-Delhom ED, Gallix BP, Achard C, Bruel JM, Janbon C. High resolution unenhanced computed tomography in patients with swollen legs. Lymphology 2002; Sep 35 (Suppl. 03) 121-128.
    PubMedGoogle Scholar
  • 36 Fonder MA, Loveless JW, Lazarus GS. Lipedema, a frequently unrecognized problem. J Am Acad Dermatol 2007; Aug 57 (Suppl. 02) S1-3.
    CrossrefPubMedGoogle Scholar
  • 37 Brautigam P, Vanscheidt W, Foldi E, Krause T, Moser E. [Involvement of the lymphatic system in primary non-lymphogenic edema of the leg. Studies with 2-compartment lymphoscintigraphy]. Der Hautarzt 1997; Aug 48 (Suppl. 08) 556-567.
    CrossrefPubMedGoogle Scholar
  • 38 Harwood CA, Bull RH, Evans J, Mortimer PS. Lymphatic and venous function in lipoedema. Br J Dermatol 1996; Jan 134 (Suppl. 01) 1-6.
    CrossrefPubMedGoogle Scholar
  • 39 Bosman J. Lipoedema: poor knowledge, neglect or disinterest?. Journal of Lymphoedema. 2011 6(2).
    PubMedGoogle Scholar
  • 40 Greer KE. Lipedema of the legs. Cutis 1974; 14: 98-100.
    Google Scholar
  • 41 Hauner H, Bramlage P, Lösch C. et al. Übergewicht, Adipositas und erhöhter Taillenumfang: Regionale Prävalenzunterschiede in der hausärztlichen Versorgung. Deutsches Ärzteblatt 2008; 105 (Suppl. 48) 827-833.
    Google Scholar
  • 42 Helmert U, Strube H. The development of obesity in Germany in the period from 1985 until 2000. Gesundheitswesen 2004; 66 (Suppl. 07) 409-415.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 43 Prugger C, Keil U. Development of obesity in Germany – prevalence, determinants and perspectives. Dtsch Med Wochenschr 2007; 132 (Suppl. 16) 892-897.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 44 Mensink GB, Schienkiewitz A, Haftenberger M. et al. [Overweight and obesity in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; May 56 5–6 786-794.
    CrossrefPubMedGoogle Scholar
  • 45 Cornely M. Konzept der operativen Behandlung der Lipohyperplasia dolorosa (Lipödem). Aesthetische Dermatologie. 2005
    PubMedGoogle Scholar
  • 46 Peled AW, Slavin SA, Brorson H. Long-term Outcome After Surgical Treatment of Lipedema. Annals of plastic surgery 2012; Mar 68 (Suppl. 03) 303-307.
    CrossrefPubMedGoogle Scholar
  • 47 Cornely M. Das Lipödem an Armen und Beinen. Teil 1: Pathophysiologie. Phlebologie. 2011: 40.
    PubMedGoogle Scholar
  • 48 Schmeller W, Meier-Vollrath I. Das Lipödem: neue Möglichkeiten der Therapie. Die verbesserten Therapiemöglichkeiten verlangen eine präzisere Differentialdiagnose. Schweizerisches Medizin-Forum. 2007 7(6).
    PubMedGoogle Scholar
  • 49 Földi M, Stößenreuther R. Grundlagen der manuellen Lymphdrainage. 2011
    PubMedGoogle Scholar
  • 50 Zelikovski A, Manoach M, Giler S, Urca I. Lympha-press A new pneumatic device for the treatment of lymphedema of the limbs. Lymphology 1980; Jun 13 (Suppl. 02) 68-73.
    PubMedGoogle Scholar
  • 51 Zelikovski A, Haddad M, Koren A. et al. Lipedema complicated by lymphedema of the abdominal wall and lower limbs. Lympho logy 2000; 33 (Suppl. 02) 43-46.
    Google Scholar
  • 52 Herpertz U. [Lipedema]. Zeitschrift fur Lymphologie 1995; Aug 19 (Suppl. 01) 1-11.
    Google Scholar
  • 53 Rockson SG. Diagnosis and management of lymphatic vascular disease. Journal of the American College of Cardiology 2008; 52 (Suppl. 10) 799-806.
    CrossrefPubMedGoogle Scholar
  • 54 Szolnoky G, Borsos B, Barsony K. et al. Complete decongestive physiotherapy with and without pneumatic compression for treatment of lipedema: a pilot study. Lymphology 2008; Mar 41 (Suppl. 01) 40-44.
    PubMedGoogle Scholar
  • 55 Szolnoky G, Kemeny L. Lipoedema: from clinical presentation to therapy. Further aspects. Br J Dermatol 2010; Apr 162 (Suppl. 04) 889.
    PubMedGoogle Scholar
  • 56 Szolnoky G, Nagy N, Kovacs RK. et al. Complex decongestive physiotherapy decreases capillary fragility in lipedema. Lymphology 2008; Dec 41 (Suppl. 04) 161-166.
    PubMedGoogle Scholar
  • 57 Szolnoky G, Varga E, Varga M, Tuczai M, DosaRacz E, Kemeny L. Lymphedema treatment decreases pain intensity in lipedema. Lymphology 2011; Dec 44 (Suppl. 04) 178-182.
    PubMedGoogle Scholar
  • 58 Wagner S. Lymphedema and lipedema – an overview of conservative treatment. VASA 2011; Jul 40 (Suppl. 04) 271-279.
    CrossrefPubMedGoogle Scholar
  • 59 Schneider WH, Erpertz U. Indikationen und Kontraindikationen der physikalischen. Ödemtherapie Orthopädie-Technik 1996; 3: 185-191.
    Google Scholar
  • 60 Deri G, Weissleder H. Vergleichende prä- und posttherapeutische Volumenmessungen in den Beinsegmenten beim Lipödem. Lymph Forsch 1997; 1: 35-37.
    Google Scholar
  • 61 Schmeller W, Meier-Vollrath I. Erfolgreiche operative Therapie des Lipödems mittels Liposuktion. Phlebologie 2004; 33: 23-29.
    Article in Thieme ConnectGoogle Scholar
  • 62 Schmeller W, Meier-Vollrath I. Tumescent liposuction: a new and successful therapy for lipedema. Journal of cutaneous medicine and surgery 2006; Jan-Feb 10 (Suppl. 01) 7-10.
    CrossrefPubMedGoogle Scholar
  • 63 Reich-Schupke S, Altmeyer P, Stücker M. Pilotstudie zur Kompressionsversorgung von Patienten mit Lipödem, Lymphödem und Lipolymphödem. Pilot study on compression therapy in patients with lipedema, lymphedema and lipolymphedema. Lymphologie in Forschung und Praxis. 2012 16(2).
    PubMedGoogle Scholar
  • 64 Schmeller WMT, Kaiserling E. Damage of lymph vessels by liposuction? An immunohistologic study. LymphForsch 2006; 10: 80-84.
    Google Scholar
  • 65 Stutz JJ, Krahl D. Water jet-assisted liposuction for patients with lipoedema: histologic and immunohistologic analysis of the aspirates of 30 lipoedema patients. Aesthetic plastic surgery 2009; Mar 33 (Suppl. 02) 153-162.
    CrossrefPubMedGoogle Scholar
  • 66 Hanke CW, Bernstein G, Bullock S. Safety of tumescent liposuction in 15,336 patients. National survey results. Dermatol Surg 1995; 21 (Suppl. 05) 459-462.
    PubMedGoogle Scholar
  • 67 Sattler G, Eichner S. [Complications of liposuction]. Hautarzt 2013; 64 (Suppl. 03) 171-179.
    CrossrefPubMedGoogle Scholar
  • 68 Sommer B, Augustin M, Schöpf E, Sattler G. Tumeszenz-Lokalanästhesie. Ein neues Verfahren der Lokalanästhesie. Deutsches Ärzteblatt. 2001 98(9).
    PubMedGoogle Scholar
  • 69 Frick A, Hoffmann JN, Baumeister RG, Putz R. Liposuction technique and lymphatic lesions in lower legs: anatomic study to reduce risks. Plastic and reconstructive surgery 1999; Jun 103 (Suppl. 07) 1868-1873 discussion 1874–1875.
    CrossrefPubMedGoogle Scholar
  • 70 Bender H, Pleiß C, Cornely M, Risse J. Lymphszintigraphie beim Lipödem. Vasomed 2007; 19 (Suppl. 02) 60-62.
    Google Scholar
  • 71 Flaggi F. Psychosocial aspects of lymphedema. Wien Med Wochenschr 2013; 163 7–8 184-186.
    CrossrefPubMedGoogle Scholar
  • 72 Stutz J. Lipödem: Ursache für schwerwiegende Essstörungen. Phlebologie 2013; 5: A10-11.
    Google Scholar
  • 73 Hauner H. et al. Interdisziplinäre Leitlinie der Qualität S3 zur „Prävention und Therapie der Adipositas“. Version 2.0 (April 2014). Adipositas 2014; 8: 179-221.
    Google Scholar