Focus Lymphology – Original article 121 Treatment of lipoedema using l i p o s u c t i o n Results of our own surveys S. Rapprich1; S. Baum2; I. Kaak3; T. Kottmann4; M. Podda5 1Dermatology Bad Soden, Bad Soden am Taunus/Germany; 2Dematological practiseim Vorderen Westen, Kassel/Ger- many; 3General Medicine Westerrönfeld/Germany; 4Medical Statistics Hamm/Germany; 55Dermatology Department, Darmstadt Hospital/Germany Keywords tients liposuction significantly reduced pain, Epidemiologie wird vorgestellt. Als Therapie- Lipedema, liposuction, lipolymphedema, life bruising and the tendency of swelling in the möglichkeit stehen die Komplexe Physikali- quality, decongestive lymphatic therapy, extremities. It therefore led to a significant im- sche Entstauungstherapie und die Liposuktion sports, epidemiology provement in the quality of life of the patients. zur Verfügung. Nur durch die Liposuktion ist Conclusion: Lipedema is a relatively common eine dauerhafte Entfernung des Fettgewebes Summary disorder among women. Liposuction forms möglich. Ihre Wirksamkeit wird in einer weite- Background: Lipedema is a painful, geneti- part of an effective treatment plan, when it is ren Untersuchung aufgezeigt und die Bedeu- cally induced, abnormal deposition of subcu- used in conjunction with pre- and postoper- tung als Teil eines umfassenden Behandlungs- taneous fat in the extremities of women. The ative complex physical decongestive therapy, konzeptes dargelegt. pathogenesis is unknown. Also unknown is a sports program, treatment of concomitant Patienten und Methodik: Für die epidemiolo- the number of women affected in Germany. obesity, as well as psychological support, if gische Untersuchung wurden in einer ländli- This study presents the epidemiology of the needed. Therefore a comprehensive treatment chen Hausarztpraxis sämtliche Patientinnen disease. There are currently two treatment plan should be aimed at for a succesful result. bezüglich Beinleiden untersucht. Die Studie options available: Complex physical decon- zur Liposuktion umfasste die prä- und post- gestive therapy and liposuction. Liposuction operative Untersuchung von 85 Patientinnen is the only method that removes fat perma- mittels Beschwerdefragebogen. nently. An additional study proves its effec- Schlüsselwörter Ergebnisse: Bei 5 % aller Patientinnen einer tiveness and highlights its vital role as part of Lipödem, Liposuktion, Lipolymphödem, Le- Hausarztpraxis wurde ein Lipödem festge- a comprehensive treatment concept. bensqualität, konservative Therapie, Sport, stellt. Mittels Liposuktion konnten bei 85 Pa- Patients and methods: As part of the epi- Epidemiologie tientinnen Schmerzen, Druckschmerz, Häma- demiological research, all patients of a gen- tomneigung und Schwellungsneigung signifi- eral practioner were examined for leg prob- Zusammenfassung kant vermindert und die Lebensqualität ver- lems. The liposuction study included the pre- Hintergrund: Beim Lipödem handelt es sich um bessert werden. and postoperative examination of 85 pa- eine schmerzhafte, anlagebedingt übermäßige Schlussfolgerung: Das Lipödem ist eine rela- tients, which was carried out using a ques- Fettgewebsvermehrung der Extremitäten bei tiv häufige Erkrankung der weiblichen Bevöl- tionnaire. Frauen. Die Ursache ist unbekannt. Ebenso un- kerung. Die Liposuktion stellt zusammen mit Results: Lipedema were diagnosed in 5 % of bekannt ist die Zahl der betroffenen Frauen in der prä- und postoperativen komplexen phy- all patients of the GP practice. In all 85 pa- Deutschland. Eine eigene Untersuchung zur sikalischen Entstauungstherapie, einem Sportprogramm und der Behandlung einer begleitenden Adipositas sowie bedarfsweise Correspondence to: Therapie des Lipödems mittels Liposuktion im einer psychologischen Unterstützung ein Dr. med. Stefan Rapprich Rahmen eines umfassenden Behandlungs - wirksames Behandlungskonzept dar. Hautmedizin Bad Soden konzeptes Kronberger Straße 2, 65812 Bad Soden, Germany Ergebnisse eigener Studien Sie kann nur im Zusammenwirken mit diesen Tel. +49-6196/651550 Phlebologie 2015; 44: 121–132 anderen Therapien erfolgreich sein und daher E-Mail: [email protected] http://dx.doi.org/10.12687/phleb2265-3-2015 ist ein umfassender Therapieplan anzustre- Received: March 7, 2015 ben. Accepted: May 5, 2015 © Schattauer 2015 Phlebologie 3/2015 Downloaded from www.phlebologieonline.de on 2016-01-05 | IP: 151.204.226.100 For personal or educational use only. No other uses without permission. All rights reserved. 122 S. Rapprich et al.: Treatment of lipoedema using liposuction Lipoedema is a constitutional, dispropor- CPDT can bring relief for a short time, but Fundamentals of tionate accumulation of fat in the female this relief is not permanent and has no in- extremities (1–2). Pain at rest and on press- fluence on the course of the disease. lipoedema ure, a tendency for bruising to occur after Liposuction is the only way to achieve In the beginning of the 1940s, Hines and minimal trauma and an increase in oede- long-lasting removal of the fatty tissue. Allen described lipoedema for the first ma over the course of the day are charac- Since the development of techniques that time (1). Since then, numerous synonyms teristic. The disease shows a chronic, pro- protect lymphatic vessels using vibrating have appeared in the literature, but know- gressive course. microcannulas and local tumescence an- ledge about this still really unknown dis- The disproportionality between the aesthesia and water jet-assisted liposuction, ease is sparse (6–7). trunk and the affected extremities is even it has become possible to treat lipoedema Depending on the source, the following obvious in case of the frequently concomi- surgically. More than 20 years’ experience names for lipoedema can be found: lipal- tant obesity. The disease is diagnosed clini- of the method has now accumulated and its gia, adiposalgia, Adipositas dolorosa (Der- cally and should be differentiated from li- effectiveness has been confirmed scientifi- cum’s disease), Lipomatosis dolorosa, Li- pohypertrophy and lymphoedema in par- cally (3–5). pohypertrophia dolorosa, painful column ticular. However, experience also shows that, in leg and painful lipoedema syndrome (2). The recommended treatment is com- addition to the surgeon’s expertise, the plex physical decongestion therapy quality of the compression treatment and Definition and staging (CPDT), consisting of manual lymphatic of the pre- and post-operative lymphatic drainage (MLD) and compression, exercise drainage, as well as diet and physical activ- Lipoedema is a disease that almost exclus- during compression and skincare. This ity for overweight patients are also crucial ively affects women (8). It is characterized treatment is only effective against the oede- for the success of treatment. Psychological by a painful symmetrical increase in fatty ma component and the compression, in support is sometimes also important. tissue in the lower extremities. In about 1/3 particular, must be used long-term. MLD is Thus the treatment concept is multi-fa- cases the arms are also affected (9–10). The required for oedema that occurs despite ceted and is based on several mainstays. result is a characteristic disproportionality compression garments. The effects of MLD These will now be described and supported of the body’s silhouette between extremities on pain are unclear. For many patients, with new study data. and the trunk (▶ Fig. 1). Fig. 1 Lipoedema of whole leg and upper arm type. Phlebologie 3/2015 © Schattauer 2015 Downloaded from www.phlebologieonline.de on 2016-01-05 | IP: 151.204.226.100 For personal or educational use only. No other uses without permission. All rights reserved. S. Rapprich et al.: Treatment of lipoedema using liposuction 123 Orthostatic oedema, sensitivity to press- ure and touch and a tendency to bruise easily are typical of the disease picture (1–2, 9, 11–12) Based on its morphology, lipoedema is Leg Other Lip- Other reasons complaints leg oedema divided into three clinical stages or degrees n = 687 n = 126 complaints n = 41 of severity. In the first stage, the finding on Fig. 2 84.5% 15.5% n = 85 32.5% palpation is still of a soft consistency and Reason for consultati- 67.5% the structure is finely nodular and homo- on of 813 female pa- geneous; the surface of the skin is smooth tients in a rural gene- ral practice (own in- and the subcutis thickened. In the second vestigation). stage, the subcutis is harder on palpation, the fatty tissue feels more nodular and the first signs of unevenness appear on the skin surface. In the third stage, the palpation tients. Of these 126 patients, lipoedema pressure is present, as well as a tendency to finding is hard and the fat lobes grossly de- was diagnosed as the cause of the symp- develop haematoma after the slightest trau- formed (12). toms in 41 (32.5 %). Lipoedema had been ma. The course is always progressive, but previously diagnosed in only 4 patients; for Spontaneous pain in the affected areas is varies widely among individuals in time all the remaining women this was the first reported, as well as feelings of tightness and and cannot be predicted. time. 5 % (41 of 813) of the patients who at- swelling (2). There is no correlation be- tended the practice suffered from lipoede- tween the morphological stages and the ex- Localisation ma. It is not possible to extrapolate to the tent of the clinical symptoms. Any con- proportion in the total population, but the comitant obesity aggravates the symptoms. Lipoedema