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Surgical Treatment for Lipedema Abstract. Lipedema is a progressive disease that occurs in adolescence and affects one in nine women. The signs are limited to the lower limbs. Early signs are nonspecific, which is why the diagnosis is often ignored. Later, pain and heaviness of lower limbs become predominant. Finally, at an advanced stage, tissue fibrosis is associated with significant edema. At this stage, patients become severely disabled and bedridden. At the early stage, the treatment is conservative. Liposuction is indicated at the onset of pain. Its effectiveness pain and long-term control has been demonstrated on. Finally, late stages require heavy and complex surgeries combining dermolipectomy and liposuction.

Introduction Lipedema (meaning edema in fat) and Dercum Disease (DD) are fat disorders in which accumulation of painful subcutaneous adipose tissue (SAT) affects more females than males, especially at times of female hormone change. Patients with both fat disorders are often misdiagnosed as obese. The purpose of this study was to determine if estrogen (ER) and progesterone receptors (PR) are different in lipedema versus DD in SAT and skin versus controls. These receptors are on mast cells that produce histamine causing leakage from blood vessels inducing hypoxia and angiogenesis. Progesterone is known to activate histamine release from mast cells. We aim to determine levels of ER and PR in SAT and if blood vessels replicate at a higher rate in lipedema and DD versus controls to help further understand these conditions and work towards finding a cure. Materials and Methods Immunohistochemistry (San Diego Pathology, San Diego, CA) was used to test for the presence of PR, ER, Ki67 (marker of replicating cells), and CD117 (marker of mast cells). Results and Discussion Mast cell numbers were similar in control, DD and lipedema SAT (Figure). ER were not different in control, DD and lipedema SAT. PR were significantly lower in lipedema SAT. There was no difference in Ki67 in lipedema or DD blood vessels compared to controls. Conclusion Lower numbers of PR in our data suggest mast cell secretions (histamine and others) could be higher inducing leakage from vessels and fluid collection in SAT. Fluid in the tissue should induce hypoxia and growth of more blood vessels. Despite higher PR on mast cells, lipedema blood vessels did not appear to be replicating at a higher level. With further research and additional samples, the relevance of elevated PR in lipedema tissue may become apparent. Support or Funding Information Research reported in this poster was supported by the National Institute of General Medical Sciences of the National Institutes of Health under linked Award Numbers RL5GM118969, TL4GM118971, and UL1GM118970. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Special acknowledgement to the Minority Health Disparities summer research program at the University of Arizona, the College of Medicine Tucson Treatment, Research, and Education of Adipose Tissue Program. This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Lipedema is a chronic metabolic disorder of the adipose tissue, of unknown aetiology, and is marked by a bilateral and symmetrical swelling of the lower extremities, caused by extensive deposits of subcutaneous fatty tissue (local lipohypertrophy). Proliferative subcutaneous fatty tissue compresses the lymph collectors of the superficial lymphatic system. Lymphedema is characterized swelling of soft tissues by accumulation of lymphatic fluid [1]. If lipolympedema remains untreated, it will progress through the same stages as pure lymphedema [1,2]. A helpful diagnostic tool to distinguish lipedema from lymphedema is Stemmers sign. Limb circumference or volume measurements are commonly used for diagnosis and for following lymphedema progression [3]. Developing technology also brings new approaches for lymphedema diagnosis: bioimpedance, 99mTc lymphoscintigraphy, magnetic resonance lymphangiography etc. Ultrasound is recently developing imaging technique for both lymphedema diagnosis and follow up [4]. In this case report localized lipedema which diagnosed with ultrasonography, in a patient with osteoarthritis in the knee joint was discussed.

Lipedema is a chronic disorder of subcutaneous adipose tissue of unknown etiology not uncommon among post-puberty women. The disease has a negative impact on selfesteem, mobility, and quality of life. Lipedema is characterized by symmetrical, disfiguring hyperplastic adipose tissue combined with bruising and pain. Untreated lipedema fosters osteoarthritis, secondary lymphedema, limitedmobility, and psychosocial stigmatization. Treatment consists of conservative complex decongestive therapy and surgery by microcannular tumescent liposuction. Liposuction is the only available treatment capable to reduce the pathological adipose tissue durable and to prevent complications.

Lipoedema is a condition characterised by symmetrical lower limb enlargement. It was first described by Allen & Hines who coined the term lipoedema. The result of subcutaneous deposition of fat gives rise to fatty swelling in the buttocks, thighs and lower limbs sparing the feet. It is associated with obesity and hence upper limbs and rarely trunks are also affected.  This Clinical condition affects females predominantly 1:4 and hence has a profound effect on the psychology therefore it is not uncommon to see these patients with a low self esteem, socially isolated and depressed. Due to its resemblance to lymphoedema it is not unusual to be misdiagnosed, thus leading to a spiral of inappropriate tests and improper treatment outcome.

INTRODUCTION: Nowadays, liposuction is the most frequently performed aesthetic surgery procedure in Western Countries. This technique has had rapid development since the 1970s, when it was experimented for the first time by A. and G. Fischer. It is currently widely used in clinical practice for many different situations in aesthetic, reconstructive and functional fields. MATERIALS AND METHODS: This review aims to describe the historical evolution of liposuction by analyzing the transformation of the method in function of the introduction of innovative ideas or instruments. We have also focused on reporting the major clinical applications of this surgical technique, applicable to almost the entire body surface. We finally analyzed the complications, both major and minor, associated with this surgical technique. RESULTS: Liposuction is mainly used to correct deep and superficial fat accumulations and remodel the body contour. It has become an essential complementary technique to enhance the aesthetic result of many other aesthetic procedures such as reduction mammoplasty, abdominoplasty, brachioplasty, thigh lift and post bariatric body contouring. However, it can be largely used for the treatment of innumerable pathologies in reconstructive surgery such as lipomas, lipedema, lipodystrophies, pneudogynecomastia and gynecomastia, macromastia e gigantomastia, lymphedema and many others. The complication rate is very low, especially when compared with conventional excisional surgery and the major, complications are generally associated with improper performance of the technique and poor patient management before and after surgery. CONCLUSION: Liposuction is a safe, simple and effective method of body contouring. It has enormous potential for its application in ablative and reconstructive surgery, far from the most common aesthetic processes with a very low complication rate.

Lipedema an often overlooked but treatable disease Lipedema is a painful disease that affects some women between puberty and menopause through a subcutaneous fat accumulation especially in the lower extremities. Patients suffer from pain and pressure tenderness. The larger fat accumulation, especially on the inside of the thighs and knees, causes walking difficulties. This can successfully be treated by liposuction with good long-term results in terms of pain reduction and prevention of osteoarthritis development in the knee and ankle joints.

Lymphoedema results from a failure of the lymphatic system. The consequences are swelling, skin and tissue changes and predisposition to infection. Lipoedema, however, results from the predisposition of an excessive number of fat cells in the lower limbs, typically from the ankle to the waist. Management for lymphoedema consists of volume reduction, reduction in shape distortion and improvement of skin condition. Treatment consists of a two-phase approach including an intensive and maintenance phase. The maintenance stage of treatment or self-care consists of skin care, exercise and compression garments. Case studies are presented featuring lower limb lymphoedema and upper limb lymphoedema and a patient affected by lipoedema. The case studies demonstrate how JOBST Elvarex custom-fit, flat-knit compression garments with knee and elbow functional zones enhances patient choice, garment suitability and potential for improved quality of life.

Self-management and the use of adjustable velcro compression wraps are not new concepts and quite often both can form part of the maintenance phase of treatment in those with lymphoedema or lipoedema, as well as those diseases in which compression therapy is advised as long-term management. The aim of this article is to identify some aspects that contribute to effective self-management and how the use of easywrap adjustable velcro compression wraps have improved quality of life for those with lymphoedema, chronic oedema and lipoedema. Case studies are given from patients to demonstrate the individual experience of living with lymphoedema or lipoedema, how this has impacted on daily life, and how using easywrap has helped as part of self-management.

Lipedema is a chronic disorder of subcutaneous adipose tissue of unknown etiology not uncommon among post-puberty women. The disease has a negative impact on self-esteem, mobility, and quality of life. Lipedema is characterized by symmetrical, disfiguring hyperplastic adipose tissue combined with bruising and pain. Untreated lipedema fosters osteoarthritis, secondary lymphedema, limited mobility, and psychosocial stigmatization. Treatment consists of conservative complex decongestive therapy and surgery by microcannular tumescent liposuction. Liposuction is the only available treatment capable to reduce the pathological adipose tissue durable and to prevent complications.

Liposuction is a procedure commonly performed in the UK usually with a low incidence of serious sequelae; however with larger patients and increased volumes of lipoaspirate, complications have been reported more frequently. One of the rare but very serious complications postliposuction is fat embolism syndrome (FES), a life-threatening condition difficult to diagnose and limited in treatment. The authors present the case of a 45-year-old woman who was admitted to the intensive care unit postelective liposuction for bilateral leg lipoedema. She presented with the triad of respiratory failure, cerebral dysfunction and petechial rash requiring a brief period of organ support. This case highlights that with the recent increase in liposuction procedures worldwide, FES is a differential to always consider. Although still a rare condition this article emphasises the importance of thinking outside the box and how to identify and manage such a lifethreatening complication.

Background Lipedema is a common painful subcutaneous adipose tissue (SAT) disorder in women affecting the limbs. SAT therapy is a manual therapy to improve soft tissue quality. Objective Determine if SAT therapy improves pain and structure of lipedema SAT. Design Single arm prospective pilot study. Setting Academic medical center. Patients Seven women, 46 ± 5 years, weight 90 ± 19 kg, with lipedema. Intervention Twelve 90-min SAT therapy sessions over 4 weeks. Outcomes Dual X-ray absorptiometry (DXA) scans, SAT ultrasound (Vevo 2100), leg volumetrics, skin caliper assessment, tissue exam, weight, resting metabolic rate, pain assessment, lower extremity functional scale (LEFS) and body shape questionnaire (BSQ) at baseline and end of study. Results Weight, resting metabolic rate and BSQ did not change significantly. Limb fat over total body fat mass (p = 0.08) and trunk fat over total body mass trended down from baseline (p = 0.08) by DXA. Leg volume and caliper assessments in eight of nine areas (p < 0.007), LEFS (p = 0.002) and average pain (p = 0.007) significantly decreased from baseline. Fibrosis significantly decreased in the nodules, hips and groin. Ultrasound showed improved SAT structure in some subjects. Side effects included pain, bruising, itching, swelling and gastroesophageal reflux disease. All women said they would recommend SAT therapy to other women with lipedema. Limitations Small number of subjects. Conclusion SAT therapy in 4 weeks improved tissue structure, perceived leg function, and volume although shape was not affected. While side effects of SAT therapy were common, all women felt the therapy was beneficial.

BACKGROUND: Lipedema is a condition consisting of painful bilateral increases in subcutaneous fat and interstitial fluid in the limbs with secondary lymphedema and fibrosis during later stages. Combined decongestive therapy (CDT) is the standard of care in most countries. Since the introduction of tumescent technique, liposuction has been used as a surgical treatment option. The aim of this study was to determine the outcome of liposuction used as treatment for lipedema. METHODS: Twenty-five patients who received 72 liposuction procedures for the treatment of lipedema completed a standardized questionnaire. Lipedema-associated complaints and the need for CDT were assessed for the preoperative period and during 2 separate postoperative follow-ups using a visual analog scale and a composite CDT score. The mean follow-up times for the first postoperative follow-up and the second postoperative follow-up were 16 months and 37 months, respectively. RESULTS: Patients showed significant reductions in spontaneous pain, sensitivity to pressure, feeling of tension, bruising, cosmetic impairment, and general impairment to quality of life from the preoperative period to the first postoperative follow-up, and these results remained consistent until the second postoperative follow-up. A comparison of the preoperative period to the last postoperative follow-up, after 4 patients without full preoperative CDT were excluded from the analysis, indicated that the need for CDT was reduced significantly. An analysis of the different stages of the disease also indicated that better and more sustainable results could be achieved if patients were treated in earlier stages. CONCLUSIONS: Liposuction is effective in the treatment of lipedema and leads to an improvement in quality of life and a decrease in the need for conservative therapy.

BACKGROUND AIMS: Lipedema is a hormone-related disease of women characterized by enlargement of the extremities caused by subcutaneous deposition of adipose tissue. In healthy patients application of autologous adipose tissue-derived cells has shown great potential in several clinical studies for engrafting of soft tissue reconstruction in recent decades. The majority of these studies have used the stromal vascular fraction (SVF), a heterogeneous cell population containing adipose-derived stromal/stem cells (ASC), among others. Because cell identity and regenerative properties might be affected by the health condition of patients, we characterized the SVF cells of 30 lipedema patients in comparison to 22 healthy patients. METHODS: SVF cells were analyzed regarding cell yield, viability, adenosine triphosphate content, colony forming units and proliferative capacity, as well as surface marker profile and differentiation potential in vitro. RESULTS: Our results demonstrated a significantly enhanced SVF cell yield isolated from lipedema compared with healthy patients. In contrast, the adipogenic differentiation potential of SVF cells isolated from lipedema patients was significantly reduced compared with healthy patients. Interestingly, expression of the mesenchymal marker CD90 and the endothelial/pericytic marker CD146 was significantly enhanced when isolated from lipedema patients. DISCUSSION: The enhanced number of CD90(+) and CD146(+) cells could explain the increased cell yield because the other tested surface marker were not reduced in lipedema patients. Because the cellular mechanism and composition in lipedema is largely unknown, our findings might contribute to a better understanding of its etiology.