A novel combined approach of stromal vascular fraction gel grafting and liposuction for postmastectomy upper extremity lymphedema: A prospective study.

Abstract

Conventional therapies for postmastectomy upper extremity lymphedema often provide limited and temporary relief, especially in advanced cases. Although surgical interventions such as liposuction have improved outcomes, combining regenerative cell-based strategies with surgical volume reduction has not been systematically evaluated. This prospective study assessed the feasibility, safety, and efficacy of combining stromal vascular fraction (SVF)-gel grafting with liposuction, targeting physical debulking and lymphatic regeneration in breast cancer-related upper extremity lymphedema. In this prospective, single-arm exploratory study, 12 patients with stage II or III breast cancer-related upper extremity lymphedema underwent liposuction followed by SVF-gel transplantation. The primary endpoint was change in excess arm volume at 12 months. Secondary outcomes included symptom severity, quality of life (QoL; Disabilities of the Arm, Shoulder and Hand [DASH] and Lymphedema Quality-of-Life Questionnaire [LYMQOL] questionnaires), incidence of cellulitis, and reliance on compression therapy. Safety was monitored throughout. Statistical analyses included repeated measures analysis of variance (ANOVA) with Bonferroni corrections, Wilcoxon, and multi-linear regression to compare changes from baseline and identify factors influencing arm volume. At 12 months, the combined intervention achieved a mean 51% reduction in excess arm volume (from 668.3 ± 275.1 to 327.5 ± 164.1 mL, P < 0.05). Significant improvements were observed in limb heaviness, tension, upper extremity function, and LYMQOL subscales (all P < 0.01). Three patients discontinued compression therapy. No cellulitis or serious adverse events occurred; minor complications resolved without intervention. Combining liposuction with SVF-gel grafting is a feasible, safe, and effective approach for advanced postmastectomy upper limb lymphedema and for improving symptoms and QoL. Given the lack of published data on this combined technique, our findings lay the foundation for future controlled studies.