A 10-Year Retrospective before-and-after Study of Lipedema Surgery: Patient-Reported Lipedema-Associated Symptom Improvement after Multistage Liposuction

Abstract

Background: Despite an increasing demand for surgical treatment of lipedema, the evidence for liposuction is still limited. Little is known about the influence of disease stage, patient age, body mass index, or existing comorbidities on clinical outcomes. It was hypothesized that younger patients with lower body mass index and stage would report better results. Methods: This retrospective, single-center, noncomparative study included lipedema patients who underwent liposuction between July of 2009 and July of 2019. After a minimum of 6 months since the last surgery, all patients completed a disease-related questionnaire. The primary endpoint was the need for complex decongestive therapy based on a composite score. Secondary endpoints were the severity of disease-related complaints measured on a visual analogue scale. Results: One hundred six patients underwent a total of 298 large-volume liposuctions (mean lipoaspirate, 6355 ± 2797 ml). After a median follow-up of 20 months, a median complex decongestive therapy score reduction of 37.5 percent (interquartile range, 0 to 88.8 percent; p < 0.0001) was observed. An improvement in lipedema-associated symptoms was also observed (p < 0.0001). The percentage reduction in complex decongestive therapy scores was greater in patients with a body mass index less than or equal to 35 kg/m2 (p < 0.0001) and in stage I and II patients (p = 0.0019). Conclusion: Liposuction reduces the severity of symptoms and the need for conservative treatment in lipedema patients, especially if it is performed in patients with a body mass index below 35 kg/m2 at an early stage of the disease. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Patient-Reported Outcomes of Liposuction for Lipedema Treatment

“…Especially in congruence with Cobos et al and Kruppa et al [33,39], this should raise awareness to the fact that many patients do not have access to this type of therapy, despite the need for it. Potentially, this contributes to disease progression with all its consequences for the individual patient.…”

“…Those findings are endorsed and subsidized by our study, as we included patients between the ages of 18 and 81, who demonstrated an overall statistically relevant improvement after undergoing surgery. As the study of Cobos et al and Kruppa et al demonstrated, stage one and two patients showed the highest improvement after liposuction leading to a positive correlation between early-stage surgical treatment and long-term outcomes of the disease [33,39]. These results underline the importance of timely disease diagnosis and treatment.…”

“…There is evidence for surgical treatment efficacy in improving QOL [23,37,38] and overall, previous studies showed positive effects upon social and daily life as well as on general health status [33,38]. Additionally, there is no age limit for the beneficial effects of liposuction for patients [29].…”

“…Several studies proposed a positive effect on quality of life, pain levels, professional performance and personal daily life [9,12,22,24,27]. Some studies suggested a concomitant lesser requirement of conservative treatment methods [23,[31][32][33]. The aim of this study was to demonstrate the outcomes of liposuction on lipedema-associated symptoms such as pain levels, swelling or a feeling of tenderness as well as the effect of liposuction on patients' QOL assessed with PHQ-9 and WHOQOL-BREF scores.…”

Lipedema stage affects adipocyte hypertrophy, subcutaneous adipose tissue inflammation and interstitial fibrosis

“…Conservative therapies, including manual lymphatic drainage, compression therapy, decongestive sports/movement therapy, skin care, and empowerment are currently considered as first line treatments (2-4). Surgical reduction of pathological SAT with lymph-sparing liposuction in wet-technique is another potential therapeutic option to improve symptoms, mobility and overall quality of life (5,6). However, the disease is frequently left undiagnosed and receiving appropriate medical care remains a challenge for patients.…”