A unique operation by Swedish surgeon Håken Brorson is bringing new hope to breast cancer patients who suffer from persistent lymphoedema - a disabling condition resulting in grossly swollen and painful arms and loss of mobility in the affected limbs.
He is using liposuction - a treatment more usually associated with the beauty industry - to treat the condition, and has transformed the lives of his patients.
When lymph glands in the armpit are removed during breast cancer surgery to prevent the cancer spreading the lymph often cannot drain away properly and lymphoedema occurs, leading gradually to an increase in the volume of the subcutaneous fatty tissue. This phenomenon is poorly understood, according to Dr Brorson, and is rarely mentioned when speaking of lymphoedema treatment as both patients and therapists believe that the arm swelling is caused only by accumulated lymph. The swelling of the arm causes pain, lack of mobility and, in many cases, considerable emotional distress.
Between 30% and 40% of breast cancer patients are affected to some degree by lymphoedema after breast surgery and radiotherapy. Current treatment by massage such as manual lymph drainage (MLD) and the wearing of a compression sleeve can remove the lymph component of the swelling if carried out early enough. However, in long-standing cases where fatty tissue hypertrophy (enlargement) has developed it is not always successful as adipose tissue cannot be removed by massage or compression. Nor are there any surgical techniques that are completely effective.
Consultant plastic and orthopaedic surgeon Dr Brorson and his team at the Department of Plastic and Reconstructive Surgery at Malmö University Hospital, have developed a novel type of liposuction which removes the fatty tissue and accumulated lymph via about 20 small (2mm) incisions along the arm. Patients are then instructed to wear a compression sleeve permanently, taking it off only for a short time for special occasions.
Dr Brorson told the European Breast Cancer Conference in Brussels today (Thursday 28 September) that he had operated on 64 patients with an average oedema volume of 1.8 litres who had suffered from serious lymphoedema for a mean duration of nine years. He had followed up his patients for six years.
"We removed, typically, around two litres of fat from the arms of these patients via liposuction. After two weeks their arm swelling was reduced by 72%, by 80% at one month, 88% at three months, 93% at six months, and 98% after one year. The reduction subsequently continued slowly and at six years it was 104% - the treated arm becoming a little smaller than the healthy arm. In addition, the range of movement in the shoulder joint increased and pain and discomfort in the arm and hand diminished, improving the daily lives of our patients considerably."
Dr Brorson stressed that it was absolutely vital that the patients continued to wear the compression sleeve after liposuction to prevent lymphoedema building up again which would lead to more fatty tissue accumulating and, in turn, increase the lymphoedema further - a vicious circle of cause and effect.
"Lymphoedema is an extremely distressing side-effect of breast cancer surgery in many women and this is a promising new treatment for chronic cases where there is a considerable component of fat in the lymphoedema and conservative treatment has therefore not been effective.
"It can change patients' lives: I shall always remember one of my patients telling me how much it meant to her to be able to walk into a shop and for the first time in many years choose a dress, confident that it would fit her and look good on her."
The Lymphoedema Unit at the Malmö University Hospital has been listed in the Sweden's National Board Catalogue of highly specialised treatment since 1998. Dr Brorson has taught the technique to plastic surgeons from several university hospitals in Sweden and it is now available nationwide.
Note: Pictures showing lymphoedema, before and after liposuction treatment are available from Dr Brorson. The Lymphoedema Unit website can be found at http://www.brorson.plasticsurg.nu After 30 September please contact Mary and Kay on 32-2-775-0203