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Lymphoedema Surgery

Lymphoedema surgery is performed to manage and alleviate the effects of lymphoedema, a condition where excess lymph fluid accumulates in the limbs due to impaired lymphatic drainage. This can result from congenital lymphatic dysfunction or secondary causes such as cancer treatment, surgery, infection, or trauma.

Surgical procedures aim to improve lymphatic flow, reduce limb swelling, and enhance mobility and overall limb function. These include microsurgical techniques such as lymphaticovenous anastomosis (LVA) and vascularised lymph node transfer (VLNT), as well as excisional procedures like liposuction and debulking surgery in more advanced cases.

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Dr Terence Goh

MBBS

MMed

MRCS

FAMS

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Indications and Benefits

  • Primary Lymphoedema

    Congenital lymphatic abnormalities may cause swelling in the legs or arms, which can worsen over time. When conservative treatments such as compression therapy are insufficient, surgery may be required to restore lymphatic function.

  • Secondary Lymphoedema

    Lymphoedema may develop after lymph node removal, radiation therapy, or trauma, commonly affecting individuals who have undergone cancer treatment (e.g., breast cancer, gynaecological cancer, melanoma). Surgery is considered when swelling becomes persistent, painful, or limits mobility despite non-surgical management.

  • Chronic and Progressive Lymphoedema

    In cases where lymphoedema progresses to severe fibrosis or fat deposition, surgical intervention may help reduce excess tissue, improve limb shape, and prevent recurrent infections such as cellulitis.

Surgical Techniques

Lymphaticovenous Anastomosis (LVA)

LVA is a microsurgical procedure that redirects excess lymph fluid into nearby veins, bypassing blocked pathways. It is most effective for early-stage lymphoedema, where some lymphatic function remains. Using supermicrosurgical techniques, LVA requires small incisions (under 2 cm) and is minimally invasive. When combined with compression therapy, it can significantly reduce swelling and improve limb function.

Vascularised Lymph Node Transfer (VLNT)

VLNT transfers healthy lymph nodes from a donor site (e.g., groin, neck) to the affected limb to restore lymphatic drainage. It is suited for moderate to advanced lymphoedema, particularly in cases of extensive lymphatic damage. By promoting new lymphatic vessel growth, VLNT helps reduce swelling over time. It may be performed alone or with LVA or liposuction, depending on the severity of lymphoedema.

Liposuction for Lymphoedema

Liposuction removes excess fat deposits that develop in later-stage lymphoedema, reducing limb volume and improving contour. It is used when compression therapy alone is insufficient. Though it does not restore lymphatic function, liposuction enhances mobility and limb appearance. Lifelong compression therapy is required to maintain results and prevent fluid reaccumulation.

Excisional Debulking Surgery

For severe lymphoedema with fibrotic tissue and functional impairment, debulking surgery removes excess tissue to improve mobility and limb shape. It is reserved for advanced cases with significant skin and soft tissue changes.

Preparing for the Procedure

Consultation and Planning

A detailed consultation determines the most appropriate surgical approach for lymphoedema management. This includes a clinical examination, lymphoscintigraphy, and ultrasound to assess lymphatic function and fluid retention. The consultation also covers post-surgical rehabilitation and compression therapy, which are necessary for long-term success.

Pre-Surgical Guidelines

Patients should discontinue blood-thinning medications at least two weeks before surgery to reduce the risk of bleeding and complications. Smoking cessation is advised at least four weeks before surgery, as smoking affects circulation and impairs wound healing.

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Step-by-Step Procedure

1. Anaesthesia Administration

LVA and VLNT are typically performed under general anaesthesia to ensure patient comfort during microsurgical procedures. Liposuction and debulking surgery may be performed under regional anaesthesia, depending on the extent of the procedure and patient suitability.

2. Microsurgical Lymphatic Repair

For LVA, supermicrosurgical techniques connect lymphatic vessels to small veins, creating an alternative drainage pathway for excess lymphatic fluid. In VLNT, healthy lymph nodes are carefully transferred and microsurgically connected to ensure viability and restore lymphatic function in the affected limb.

3. Limb Volume Reduction (Liposuction or Debulking)

In liposuction, microcannulas are used to remove excess fat deposits while preserving lymphatic structures, reducing limb size and improving contour. Excisional debulking removes fibrotic tissue and redundant skin in cases of severe swelling, improving mobility and reducing infection risk.

4. Incision Closure and Post-Surgical Support

Microsurgical incisions are minimal, requiring fine sutures for precise healing and reduced scarring. For debulking procedures, larger incisions are carefully closed using specialised wound management techniques to support proper healing.

Post-Procedure Care and Recovery

Immediate Care

Mild swelling and bruising are common in the first few weeks following surgery. These symptoms gradually subside as the body heals. Patients are advised to wear compression garments continuously to support healing, reduce swelling, and maintain lymphatic flow.

Recovery Timeline

In the first two weeks, swelling decreases, and incisions begin to heal. By four to six weeks, patients can resume daily activities while continuing compression therapy. Between three and six months, swelling and limb function improve, allowing for a gradual return to physical activity. For long-term recovery, regular monitoring and ongoing compression therapy help maintain results.

Aftercare Recommendations

Maintaining a healthy weight reduces strain on the lymphatic system and supports long-term outcomes. Regular movement is necessary, as it enhances lymphatic flow and prevents fluid buildup. Physiotherapy helps improve limb strength, mobility, and overall function after surgery.

Potential Risks and Complications

Lymphoedema surgery is generally safe, but risks include wound healing delays, minor infections, and partial flap failure in VLNT, which may require further intervention. Some patients may experience persistent swelling in cases of extensive lymphatic damage or temporary or permanent sensory changes in the treated area.

Frequently Asked Questions (FAQ)

How do I know if I am a candidate for lymphoedema surgery?

Surgical treatment is considered if lymphoedema persists despite conservative management, particularly in cases with recurrent infections, progressive swelling, or functional limitations. A thorough assessment helps determine suitability.

How long do results last after surgery?

Microsurgical procedures offer long-term improvements, particularly in early-stage lymphoedema. For advanced cases, liposuction and debulking surgery help restore limb shape and function, but ongoing compression therapy remains necessary to prevent fluid build-up.

How long do I need to wear compression garments after surgery?

Compression garments should be worn continuously for at least six months after surgery, depending on the procedure performed. In most cases, long-term use is recommended to prevent fluid reaccumulation and maintain results.

How does weight affect lymphoedema surgery outcomes?

Excess body weight can increase lymphatic load and worsen swelling. Patients with a higher BMI may have a slower recovery and need stricter post-surgical care. Maintaining a healthy weight through diet and activity improves long-term results.

Can lymphoedema return after surgery?

Surgery can reduce swelling and improve limb function, but lymphoedema is a chronic condition that requires lifelong management. Without compression therapy, physiotherapy, and proper skin care, fluid accumulation may gradually return, especially in advanced cases.

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Dr Terence Goh

Choosing to combine the intricate skills of microsurgery with aesthetic surgery, Dr Goh specialises in gynaecomastia, surgery of the Asian face, particularly Asian eyelid surgery and rhinoplasty.

Blending the precision of microsurgery with the artistry of aesthetic surgery, Dr Goh has a special interest in gynaecomastia, facial procedures, including ptosis and eyelid surgery, as well as rhinoplasty.

He also offers a full range of body contouring procedures such as mummy makeovers, breast augmentation, liposuction, and body sculpting—designed to help patients feel more confident and comfortable in their own skin.

Beyond aesthetics, Dr Goh remains active in reconstructive microsurgery, with expertise in breast reconstruction, head and neck reconstruction, and lower limb salvage—restoring both form and function where it’s needed most.

  • Bachelor of Medicine, Bachelor of Surgery, National University of Singapore
  • Master of Medicine, National University of Singapore
  • Member of the Royal College of Surgeons
  • Fellow of the Academy of Medicine, Singapore (Plastic Surgery)
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