At What Stage of Lymphedema does Surgery Become Necessary?

Just beneath the skin is a vast network of lymph vessels. The lymph system is responsible for flushing toxins and waste products out of the body. Fluid travels through the lymph system and passes through various lymph nodes and vessels, where toxins are removed and the fluid receives necessary white blood cells. Lymphedema occurs when there is a backup of lymph fluid somewhere in the body. This backup usually occurs in an arm or leg. Here, we explain the stages of lymphedema and which approaches to care are warranted in each. 

The Stages of Lymphedema

Stage 1 lymphedema involves the abnormal flow of lymph fluid through the lymph system without symptoms. 

Stage 2 lymphedema involves fluid accumulation and swelling. If the affected area is pressed upon, an indentation occurs. Swelling may diminish what the affected limb is elevated.

Stage 3  lymphedema presents as permanent swelling that does not improve with elevation. If the affected area is pressed upon, no indentation occurs. This could be because the skin has become thicker and scarring has developed. 

Stage 4 lymphedema involves evident deformity of the affected limb. This is referred to as elephantiasis. In addition to deformity, the skin is noticeably thickened and extensive scarring or wart-like growths occur. 

What You Can Do at Home to Manage Lymphedema

Home remedies for lymphedema are most effective in Stages 1 and 2, when swelling is mild. To reduce swelling, patients may engage in infection prevention as directed by their physician, elevation of the affected limb, compression, massage, and physical therapy. Lymphedema management is not something a person should do on their own. Direction from a lymphedema specialist is critical to successful outcomes. 

Surgery for Lymphedema

Lymphedema is an incurable condition. Despite medical management, a patient may eventually require surgery to achieve longer-lasting improvement. There are several surgical approaches a doctor may consider. These include:

• Liposuction, to remove extra fat caused by lymphedema. 
• Lymphaticovenous anastomosis, or lymphovenous bypass surgery. This procedure reroutes lymph flow around damaged nodes, connecting vessels directly to veins. 
• Vascularized lymph node transfer moves healthy lymph nodes from one part of the body to the affected area to restore more efficient flow. 

Full recovery from lymphedema may not be possible. However, restored comfort is. For more information about lymphedema surgery, call 323.442.0416 and schedule a visit to one of our offices at Keck Medicine USC.