Lymphoedema
Lymphoedema is a chronic swelling caused by a disruption in the lymphatic system’s drainage, usually affecting the arms or legs – it cannot be cured, but it can be managed effectively.
Lymphoedema
Lymphoedema is a chronic swelling of parts of the body – usually the arms or legs – that is visible and palpable, caused by a disruption in the lymphatic system’s drainage function. It is incurable, but can be treated and managed very effectively with Complex Physical Decongestive Therapy (CPDT), which comprises lymphatic drainage and compression.
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Important note
This article is for information purposes only and is not a substitute for a medical diagnosis or advice. If you are unsure, or if you require a personalised treatment plan, it is essential that you consult a qualified specialist.
Definition: What is lymphoedema?
Lymphoedema is a chronic swelling of parts of the body (usually the arms or legs) that is visible and palpable, caused by a disruption in the lymphatic system’s drainage.
If the lymphatic vessels are damaged or overloaded, the protein-rich lymph fluid can no longer be adequately drained from the tissue. It accumulates between the cells, leading to progressive swelling and changes in the tissue.
Primary versus secondary lymphoedema: the causes
There are two fundamentally different types of lymphoedema:
Primary (congenital) lymphoedema
A rare condition caused by a congenital malformation of the lymphatic system. For example, the vessels may be too narrow or there may be too few of them. The swelling often occurs as early as puberty or in early adulthood without any apparent cause.
Secondary (acquired) lymphoedema
This is by far the most common form. In this case, the lymphatic system was originally healthy but was damaged by an external event. The most common causes are:
- Surgery involving the removal of lymph nodes: The classic example is arm lymphoedema following breast cancer surgery.
- Radiotherapy: It can cause the fine lymph vessels to become blocked.
- Injuries and infections: Severe bruising or recurrent inflammation can damage the lymphatic system.
- Cosmetic procedures: Even following extensive liposuction, temporary or (rarely) permanent damage to the lymphatic vessels may occur.
The key difference: lymphoedema vs. lipoedema
These two conditions are often confused, but they are fundamentally different.
| Characteristic | Lymphoedema | Lipedema |
|---|---|---|
| Cause | Accumulation of lymph fluid | Abnormal fat distribution |
| Affected departments | Often affects only one side (e.g. one arm); feet and hands are affected | Always symmetrical (both legs/arms); feet/hands are free |
| Pain | Usually painless (a feeling of tightness) | Severe pain when pressure is applied, tendency to bruise |
| Stemmer symbol | The fold of skin over the toes cannot be lifted | The skin fold can be lifted easily |
The 4 stages of lymphoedema
Untreated lymphoedema progresses. Medical professionals classify it into four stages:
- Stage 0 (latent stage): The lymphatic system is damaged, but there is no visible swelling yet.
- Stage 1 (Reversible stage): The swelling is soft and will subside on its own if the area is elevated.
- Stage 2 (spontaneously irreversible stage): The swelling is hardened (fibrosis) and no longer subsides when the affected area is elevated.
- Stage 3 (Elephantiasis): Severe swelling accompanied by skin changes, an increased risk of infection and restricted mobility.
The treatment: Complex Physical Decongestive Therapy (CPT)
Lymphoedema cannot be cured, but it can be treated very effectively with Complex Physical Decongestive Therapy (CPDT). The therapy must be continued for life and consists of two phases and four pillars:
Phase 1: Decongestion
Intensive treatment is carried out here every day to reduce the volume. The two main pillars are:
- Manual lymphatic drainage (MLD): Gentle, circular massage strokes stimulate the remaining lymphatic vessels to drain away the accumulated fluid.
- Compression therapy: Immediately after the MLD treatment, the decongested leg or arm is wrapped tightly with special bandages to prevent it from swelling up again.
Phase 2: Maintenance
Once the maximum result has been achieved, treatment is switched to a maintenance regimen:
- Made-to-measure compression stockings: Replace the bandages; they must be worn every day.
- Skin care & exercise: Careful skin care helps prevent infections. Special decongestive exercises help to promote lymph flow.
Risks following cosmetic surgery and financial protection
Secondary lymphoedema is a recognised, serious complication following surgical procedures. Treatment – in particular the lifelong need for manual lymphatic drainage and custom-made compression stockings – can incur significant costs.
Protection against follow-on costs
If lymphoedema requiring treatment develops following a purely cosmetic operation (such as liposuction), disputes may arise with the health insurance provider regarding the coverage of costs for the long-term treatment. A policy taken out prior to the procedure Consequential Costs Insurance provides important cover in this regard. It covers the costs of medically necessary treatment required to manage such a post-operative complication.
You can find further information on covered procedures on the overview page for treatments and procedures, as well as in the frequently asked questions.
None
Frequently Asked Questions (FAQ) about lymphoedema
Highly specialised centres offer microsurgical procedures (e.g. lymphatic vessel transplantation). However, KPE always remains the standard treatment. In stage 3, liposuction may be advisable to remove the excess fatty tissue.
The right person to consult is a specialist in lymphology or a phlebologist (vein specialist).
Yes, absolutely! Exercise (particularly swimming, aqua aerobics and walking) whilst wearing compression garments is extremely important, as the muscle pump stimulates lymph flow.
The tissue becomes increasingly hardened (fibrosis), the swelling worsens (to the point of elephantiasis) and the risk of serious skin infections (erysipelas) rises dramatically.
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