Lymphoedema Treatment

Lymphoedema is a condition characterised by the abnormal accumulation of protein-rich fluid in tissues, resulting from impaired lymphatic drainage. This leads to swelling, discomfort, and potential complications such as infections. It is often a chronic condition that significantly affects patients’ quality of life, causing physical, emotional, and social distress.

Lymphoedema can be categorised into two primary types:

1. Primary Lymphoedema:

• Cause: Hereditary or congenital, resulting from abnormalities in the development of the lymphatic system.
• Age of Onset: It can appear at any age, but commonly manifests during puberty or adulthood.
• Examples: Milroy’s disease, Mand eige’s disease.

2. Secondary Lymphoedema:

• Cause: Acquired due to external factors, such as trauma, surgery, radiation therapy, or infections that damage or obstruct the lymphatic vessels.
• Common Causes:
  • Cancer-related Lymphoedema: The most prevalent form,
    particularly after treatments such as surgery or radiation therapy. Research suggests that approximately 40% of breast cancer
    patients who undergo axillary lymph node dissection (ALND)
    and 64% of patients undergoing groin lymph node dissection
    develop secondary lymphoedema.
  • Infections: Filariasis, a parasitic infection, is a common cause in some parts of the world.

The treatment for lymphoedema depends on the severity and underlying cause of the condition, as well as the patient’s response to various therapies. Treatments are generally divided into conservative management and surgical interventions.

Conservative Management

Conservative treatments focus on symptom control, reducing fluid accumulation, and preventing complications. Key therapies include:

1. Complex Decongestive Therapy (CDT): A comprehensive, multi-faceted approach that includes:
   • Manual Lymphatic Drainage (MLD): A specialised massage technique used to stimulate the movement of lymph fluid.
   • Compression Therapy: The use of compression garments (sleeves, stockings, or bandages) to help reduce swelling and prevent fluid from accumulating.
   • Exercise: Physical activity, often combined with compression, to improve lymphatic circulation and reduce swelling.
   • Skin Care: Proper hygiene, moisturising, and monitoring for signs of infection to reduce the risk of cellulitis.
2. Exercise Under Compression: Exercises performed while wearing compression garments help promote lymphatic drainage through muscle contractions.

Surgical Management

Surgical treatment may be considered when conservative measures fail, or when the patient has advanced lymphoedema that significantly impacts daily life.

1. Physiological Surgeries: These aim to restore or enhance lymphatic flow.
   • Lymphovenous Anastomosis (LVA): Involves creating connections between lymphatic vessels and veins to help bypass blockages or
     damaged areas, allowing lymph fluid to drain directly into the
     bloodstream.
   • Vascularized Lymph Node Transfer (VLNT): Healthy lymph nodes from a different part of the body are transferred to the affected area to assist in lymph drainage.
2. Ablative Surgeries: These aim to remove excess tissue caused by chronic lymphoedema.
   • Charles Procedure: Involves removing damaged skin and subcutaneous tissue to reduce swelling, followed by skin grafting to cover the affected area.
   • Suction-Assisted Lipectomy (Liposuction): Removes excess fatty tissue that accumulates as a result of chronic swelling and lymphoedema.

Request a consultation with Dr Hsieh for a detailed discussion of the risk and type of procedure that is most suited for you. During the consultation. Dr. Hsieh will run through your risk assessment and suggest ways to minimise them. We are here to help you make an informed decision. 

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Take the next step in your lymphoedema journey. Request a consultation with Dr. Hsieh for personalised risk assessment and support in decision-making.