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shortness of breath, constipation, and fatigue. As the same small incision used for liposuction. There was
reported by Hansson et al., Dercum’s disease is classified no recurrence, and the cosmetic outcome was highly
into: generalized diffuse adiposity, generalized nodular satisfactory.
adiposity [Figure 4], localized nodular adiposity, and
juxta‑articular adiposity. [15,16] POSTTRAUMATIC LIPOMAS

Hansson traditional treated 53 patients with Dercum’s
disease that had been operated on with liposuction. As The pathogenetic link between soft tissue trauma and
controls, 58 nonoperated subjects with Dercum’s disease formation of lipomas remains controversial. A proposed
and 41 obese abdominoplasty patients were followed mechanism is the prolapse of adipose tissue through the
for 5 years. Hansson suggested that liposuction might fascia defect resulting from direct impact. An alternate
alleviate pain in patients with Dercum’s disease. However, explanation is the formation of adipose tissue as a result
it is difficult to determine whether the effect is due to the of preadipocyte differentiation and proliferation mediated
actual surgery or to other factors. by cytokine release following trauma and hematoma
formation.
Women are more affected by this condition and, it
[20]
usually presents in ages between of 30 and 50 years. The Aust et al. used the simple excision method in
differential diagnosis for this condition includes: familial 22 cases and used the liposuction method in 1 case and
lipomatosis, multiple symmetric lipomatosis, adipose recommend both techniques.
tissue tumors, panniculitis, lipedema, and fibromyalgia.
Dercum’s disease is diagnosed based on patient’s history CHRONIC LYMPHEDEMA
and the physical findings. There are no specific laboratory
tests for this disease. In chronic lymphedema, there is a physiological imbalance
of blood flow and lymphatic drainage. The decreased
The treatment strategies for this condition are mostly lymphatic drainage results in impaired clearance of lipids
based on case reports. Treatment of Dercum’s disease is and deposition of fat in subcutaneous tissue.
usually targeted towards pain relief rather than lipoma
removal. Currently, there is a lack of scientific data Lymphedema may be inherited (primary) or caused by
[17]
on the use of integrative therapies for the treatment or injury to the lymphatic vessels (secondary). It is most
prevention of Dercum’s disease. frequently seen after lymph node dissection, surgery, and/
or radiation therapy, most notably in the treatment for
De Silva and Earley used liposuction in the breast cancer. In many patients with cancer, this condition
[18]
treatment of two patients with juxta‑articular adiposis does not develop until months or even years after therapy
dolorosa (Dercum’s disease), and recommended have concluded. Lymphedema may also be associated with
liposuction as an effective, has a low morbidity and is trauma or conditions that inhibit the lymphatic system
well‑tolerated by the elderly.
function. In tropical areas, a common cause of secondary
lymphedema is filariasis, a parasitic infection. It can
SUBCUTANEUS LIPOMAS also be caused by cellulitis as it compromises lymphatic
drainage.
A lipoma is a benign tumor composed of adipose tissue.
It is the most common benign soft tissue tumor. Lipomas While the exact cause of primary lymphedema is still
are often soft to the touch, mobile, and painless. Many unknown, it occurs due to poorly developed or missing
lipomas are small (under 1 cm diameter) but can enlarge lymph nodes or channels. Lymphedema may be present
to sizes greater than 6 cm. They are commonly found in at birth, develop at the onset of puberty (praecox), or
adults from 40 to 60 years of age, but can also be found in adulthood (tarda). Lower‑limb primary lymphedema
in younger adults and children. is most common in men, occurring in one or both legs.
Secondary lymphedema affects both men and women. In
Al‑basti and El‑Khatib successfully reported the women, it is most prevalent in upper limb after breast
[19]
treatment of subcutaneous capsulated giant (more than cancer surgery and lymph node dissection. It occurs on
10 cm diameter) and moderate (5 cm to 10 cm diameter) the same side as surgery. Cancer treatment is the most
sized lipomas by traditional liposuction. The capsule was common cause of secondary lymphedema in western
extracted surgically by the end of the procedure from countries. Between 38% and 89% of breast cancer patients
suffer from lymphedema due to axillary lymph node
dissection and/or radiation, [21‑23] Unilateral lymphedema
occurs in up to 41% of patients after gynecologic
cancer. For men, a 5‑66% incidence of lymphedema has
[24]
been reported in patients treated with radical removal of
lymph glands.
The first report of use of liposuction to reduce the size
a b of lymphedema of the extremity was published by O’Brien
[26]
[25]
Figure 4: Dercum’s disease. (a) Preoperative anterior and (b) 19 months et al. and Brorson. Developed a pressure‑measuring
postliposuction device to optimize compression treatment of lymphedema
Plast Aesthet Res || Vol 2 || Issue 1 || Jan 15, 2015 3