Liposuction of arms

By Tatjana van der Krabben

On October 30^th, 2012 I’ve had liposuction on my arms. The purpose for this was the same as for my legs: pain relief from the lipedema and a better lymph flow. I can now look back on a total of 4 procedures and was quite convinced this would be a breeze, it being such a small area by comparison. So far my experience had been the larger the area, the more discomfort. I was wrong. This surgery came with a vengeance. That’s strictly personal: if you ask other lipedema ladies after multiple surgeries which one was the worst, they was all name a different one. So I took my time to see where this was going and wrote this blog a few weeks later than anticipated.

The surgery was no shorter than the other ones I had: a small area also meant continuously working from different angles and switching between different cannulas. This was sculpting all the way. It was quite relaxed: I knew the procedure and the doctor and his assistants were familiar faces by now. There was plenty of time for small talk. Which, in my case, is a lot of talking shop: this man knows stuff about research I love to hear! But I could already tell something was ahead I never experienced the other times. I had to keep my arms in certain raised positions for extended periods of time, which is tough in case of lipedema. I also had trouble lying on my side, on an already by tumescent inflated arm. So afterwards, the first 48 hours or so, I also had sore muscles on top of the surgical pain. I came close to taking the stronger pain medication that was also provided, but I also had an upset stomach. The only stronger pain killer that doesn’t make me ill is ibuprofen and due to its blood thinning properties that’s the one thing I couldn’t take. Tough luck. On day 2 post op I took a shower and gently applied some SLD on the lymph nodes in my arm pits. That was too much: I got sick after all. That set me back in my recovery. Shame.
Yet, at the same time I could tell some things were going really well. I was warned my hands would most likely swell as well and that didn’t happen. The cuts were also looking very decent; no hint of infection. So my body didn’t have all that much trouble coping and only my stomach was out of sync. By day 4 the healing itch came up. Something to dread and welcome. Can’t scratch a tender area like that! At the same time it’s a signal the healing has begun.

After a week the area got tender all over again. I could barely tolerate my compression sleeves, was constantly adjusting them. I checked and the major lymph paths were on overload. I could trace them from my elbows to my armpits, feeling to the touch like electrical wire full of little nodes. If it wasn’t so painful and a sure sign the lymph paths being very unhappy I would call it fascinating. Of course I also had this sort of thing in my legs; hard patches of trapped lymph fluid in need of clearing. You get pumped full of tumescent fluid, wounds always swell and all this has to be transported out.  Not a strong point in case of lipedema. In the legs there was still so much fat left, I couldn’t feel it in such detail. Also, in my legs it didn’t cause these stings and burning sensations that send chills down my spine.

The pain was extremely local: lymph only and pain like it involved nerves. All else was fine. I resorted to SLD 4 times a day. It took a week to see true improvement. By then I could still track the lymph paths, but the additional lumps and bumps were gone. Since it was so local and responding to SLD I wasn’t alarmed. All the signs were good: cuts were healing better than ever, no swelling in hands, annoying itch.  So I continued my SLD routine, ate quite clean (low sugar, low wheat, low additives) and tried my patience. It’s been over 5 weeks now. I can only track parts of my lymph at this point. This will take time, but I’m convinced it will improve matters like with my legs. The band of my wrist watch is feeling more loose. That bit never got ‘sucked’; the surgeon only did my upper arms and a small portion just below the elbow. The general lymph flow is benefitting from the procedure already. This is identical to what I experienced with my lower legs. From my lower legs relatively little was extracted, but they cleaned up best of all areas! Taking bulk away further up the lymph path paid off. Laser has been applied during the procedure to help the skin retract. However,  for a final result I will have to be patient. Even though improvement can very often be detected early, a final result usually takes 6-9 months. It was a bumpy ride, so I took a week before getting back to work. At first no more than 2 hours a day.

I’ve included some pictures to get an idea what it all looked like. These show where I'm coming from:

Next, 4 days post op:

Current state, 5 weeks post op:

Seeing them all together I must say: not bad! My tape measure is a big fat lier!

Liposuction as a medical treatment

By Tatjana van der Krabben

Liposuction can be applied as a medical treatment. I’m not referring to treatment of psychological issues, but liposuction as a surgery to help improve a physical condition called lipedema. I speak from experience: I’ve had four treatments. Why four? What has been treated extends well beyond the usual bikini issues treated with liposuction. I was treated section by section. The aim of these treatments is to have fat removed that will not budge when on a diet. In fact, I’m done with diets as such. My adapted food regime is a lifestyle. Like with diabetes, lipedema requires a permanently adapted food regime to keep the condition in check. The excess fat on the legs and quite often also the arms causes pain and discomfort. As we grow in size, the pain increases and mobility decreases. Removing fat takes away from the pain and discomfort and enhances mobility.

This sounds very straightforward, but there’s a catch: liposuction is not a cure, it doesn’t tackle any causes. Afterwards you could still gain. Also, it’s usually not reimbursed by insurance companies and doctors are mostly unfamiliar with this option and won’t refer. Lipedema is therefore in relatively few cases treated with liposuction. The option is more available in Europe, mostly Germany, where quite a few plastic surgeons and dermatologists perform liposuction on lipedema patients.

There’s one more catch: generally you get your treatment in the private sector at your own initiative. It’s easy to get caught up in glossy websites and luring advertisements that promise ‘easy, little invasive liposculpture’ or something. Wrong: It’s not easy, it’s invasive and it’s surgery. The lack of knowledge regarding this option, both with respect to its existence and what it entices, has prompted me to approach the media. The Dutch magazine Libelle (issue 46, 2012) has featured a  story regarding my experiences after my first liposuction. Below you find a translation of the article.

Note: since the article doesn’t feature pictures or any other images no scan of the original article was added. Also, I came well prepared for this surgery and expected pain, the secretion from the cuts and swelling. The surgeon send me home with stronger pain medication just in case, yet actually experiencing it was something else. For informative purposes the article contains more question marks than I actually had in the moment.


The day after….I had liposuction
Tatjana (39): “It’s 9.15 when the surgeon’s phone call wakes me up. He wants to know how I feel after the liposuction treatment I underwent yesterday. I feel horrible, did not anticipate to be in this much pain. I tell him and explain the compression pantyhose I’m wearing is soaked with blood and fluid. Fourteen small cuts were made in my legs and they are still secreting fluid. He recommends painkillers he gave me. He explains the oozing is normal, but I can shower, provided I don’t take off the pantyhose. My husband assists me when showering and is feels great to rinse my body. Afterwards I blow dry the pantyhose: a hint the surgeon gave me. Next I get back into bed. My legs are stiff and sore and I have trouble bending my knees. I kill time reading and chatting on my laptop. I also call my mother, who’s taking care of my children today. I don’t want them to see me this way. My mother offers to take them one more night and I’m grateful for the offer. I look at my upper legs. I know it will take weeks before the worst of the swelling is gone and before I’ll be able to tell if the surgery was a success, but I can’t resist looking at my legs. I want the surgery to be a success so bad, to regain mobility and be rid of that continuous pain in my legs. It scares me that my legs now look worse than ever before and cause me more pain than ever before. Stories of failed surgeries I read about online shoot through my head. But something had to be done.

During my first pregnancy I gained 23 kilograms. The last trimester I could barely walk because of the pain in my legs. I thought it would be over after the pregnancy, but after giving birth I lost weight everywhere but on my legs. Lipedema, my physiotherapist concluded, a hereditary condition that aggravates under the influence of hormonal changes. After my second pregnancy it became even worse. My upper body was two sizes smaller than my lower body. I could only walk short stretches and it was hard for to me to take care of my children. That was my biggest motivation to see this surgery through: I just wanted to be there for my kids. It’s 16.00 already. I hardly ate anything. My husband asks if I feel like having sushi, he knows how much I love that. ‘Yes please’, I say. I check my legs again and notice the oozing has thankfully stopped. I find it hard to accept it will take weeks to learn more about the result, but I will just have to accept that. By 9 p.m. I go back to sleep, I’m exhausted. I can only hope for a good outcome. In the end I will need two more surgeries to  get my legs in better shape. But my life will get better. In a year I will be able to do my own housework again, take on activities with the kids and exercising becomes easier. My legs will be much thinner and my new shape makes it much easier to shop for clothes.”