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Liu et al. Plast Aesthet Res 2020;7:6 Plastic and
DOI: 10.20517/2347-9264.2019.62 Aesthetic Research

Original Article Open Access

Indocyanine green lymphangiography-guided
liposuction in breast cancer-related lymphedema

treatment - patient selection and technique

Hin-Lun Liu, Melody Man-Kuen Wong, Joseph Hon-Ping Chung

Division of Plastic and Reconstructive Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong
SAR, China.

Correspondence to: Dr. Hin-Lun Liu, Division of Plastic and Reconstructive Surgery, Department of Surgery, The University of Hong
Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China. E-mail: lawrencehlliu@gmail.com

How to cite this article: Liu HL, Wong MMK, Chung JHP. Indocyanine green lymphangiography-guided liposuction in breast cancer-related
lymphedema treatment - patient selection and technique. Plast Aesthet Res 2020;7:6. http://dx.doi.org/10.20517/2347-9264.2019.62
Received: 27 Nov 2019 First Decision: 13 Jan 2020 Revised: 19 Jan 2020 Accepted: 7 Feb 2020 Published: 20 Feb 2020

Science Editor: Xiao Long Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract

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.

Keywords: Lymphedema, breast cancer-related lymphedema, liposuction, indocyanine green lymphangiography

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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