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Aim: The rationale of using liposuction to treat lymphedema is that the chronic inflammatory process of lymphedema results in fat hypertrophy. The authors describe the technique of indocyanine green lymphangiography-guided liposuction, its rationale, and our patient selection criteria for better clinical outcomes. Methods: Thirty-two patients underwent liposuction for breast cancer-related lymphedema. Indocyanine green lymphangiography was performed prior to liposuction. For patients without linear and splash patterns in indocyanine green lymphangiography, circumferential liposuction was performed liberally. For patients who had linear or splash patterns, liposuction was not performed at regions with remaining functional lymphatic vessels. Outcomes were assessed using circumferential reduction rate. Results: At a mean follow-up of 24.5 ± 6.5 months, all (100%) patients had a reduction in limb circumferences after liposuction. The mean circumference reduction rate was 67.6% ± 27.9%. Conclusion: Liposuction is a valuable treatment for breast cancer-related lymphedema. We believe patients with fat predominant lymphedema are the best candidates for liposuction.

Indocyanine green lymphangiography-guided liposuction in breast cancer-related lymphedema treatment - patient selection and technique