Lymphedema Leads to Fat Deposition in Muscle and Decreased Muscle/Water Volume After Liposuction: A Magnetic Resonance Imaging Study
Mattias Hoffner, Pernilla Peterson, Sven Ma˚nsson, and Ha˚kan Brorson. Lymphatic Research and Biology 2017
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Lymphedema Leads to Fat Deposition in Muscle and Decreased Muscle/Water Volume After Liposuction: A Magnetic Resonance Imaging Study
Mattias Hoffner, Pernilla Peterson, Sven Ma˚nsson, and Ha˚kan Brorson. Lymphatic Research and Biology 2017
Background: Lymphedema leads to adipose tissue deposition. Water–fat magnetic resonance imaging (MRI) can quantify and localize fat and water. The presence of excess fat and excess water/muscle in the subfascial compartment of the lymphedematous limb has not been investigated before. The aim of this study was to investigate epifascial and subfascial fat and water contents in patients with chronic lymphedema before and after liposuction.
Methods and Results: Seven patients with arm lymphedema and six with leg lymphedema were operated on. The limbs were examined with water–fat MRI before liposuction (baseline) and at five time points. Complete reduction of the excess limb volumes was achieved. The excess epifascial fat was evident in the edematous limbs and a drop was seen following surgery. There were differences in excess water at all time points. At 1 year there was a decrease in excess water. Excess subfascial fat was seen in the edematous limbs at all time points. Subfascial excess water/muscle did not show any differences after surgery. However, starting from 3 months there was less subfascial water/muscle compared with baseline.
Conclusions: Subfascial fat in the lymphedematous limbs did not change. In contrast, the water in the subfascial compartment was reduced over time, which may represent a decrease of muscle volume after treatment due to less mechanical load after liposuction. Using water–fat MRI-based fat quantification, the fat and water contents may be quantified and localized in the various compartments in lymphedema
Main findings
- At 1 year there was a significant decrease compared with baseline in excess water volume which may have been caused by efficient use of compression garments. No difference in the epifascial excess water volume was seen between the extremities in healthy controls.
- From 3 months there was a significantly smaller subfascial water/muscle volume compared with baseline. No difference in the subfascial excess water/muscle volume was seen between the extremities in healthy controls.
- The reason for this is unclear, but is most likely due to a switch from a hypertrophied muscle cell state to a normal muscle cell state caused by less mechanical load from the heavy lymphedematous extremity.
- The decrease in muscle volume after treatment may be caused by less mechanical load after liposuction.
- Statistical analysis was performed without differentiating between arm and leg lymphedema. Consequently, we cannot exclude that outcomes might be different for arms and legs.
