General questions about lymphedema surgery and the Functional Lymphedema Operations (FLO System®) are answered here. See below for specific questions about the VLNT, LVA and SAPLSM procedures.
Quick links to:
What are the goals of Dr. Granzow’s FLO System®?
The goals of the FLO System® system include:
- Reduce the risk of dangerous infections such as cellulitis
- Reduce arm or leg size/excess volume to normal
- Improve mobility and function
- Improve activities of daily living
- Restore the ability to wear normal clothing or footwear
- Feel better, restore confidence and psychological well-being
- Restore intimacy and closeness with your spouse and loved ones
- Reduce the social stigma of lymphedema
Are the lymphedema surgeries in the FLO System® safe for me?
The lymphedema surgeries that are part of Dr. Granzow’s comprehensive FLO System® are safe, meaning that they have standard surgical risk comparable to other surgical procedures of similar length of time. Patients having lymphedema surgeries as part of the FLO System® have experienced significantly decreased rates of infection and cellulitis. Please note that debulking procedures, such as the Charles Procedure, are not part of Dr. Granzow’s FLO System®.
I’m an out of town patient. Can your office help me plan a visit?
Yes, we have a large number of patients who travel long distances to be seen and treated by Dr. Granzow and his team. Our office will be happy to assist you with planning a visit.
Have you published any medical articles about lymphedema surgeries or the FLO System®?
Yes, Dr. Granzow has published multiple studies in the some of the most prestigious medical journals. Click here to see his publications.
Why should I work with a trained lymphedema therapist?
Dr. Granzow’s FLO System® has been successful in treating lymphedema using a combination of effective surgical technique and integrated lymphedema therapy that is specifically tailored to each patient. Patients should be evaluated and treated by a trained lymphedema therapist prior to being considered for surgery. A patient who receives proper lymphedema therapy will experience a more successful outcome after lymphedema surgery. Dr. Granzow believes that a patient should be treated by their own therapist in their home area both before and after surgery whenever possible.
Why does Dr. Granzow believe that lymphedema surgery is a team effort?
Dr. Granzow’s philosophy in the FLO System® is based on a patient-centered rather than physician-centered system of care to achieve the best results possible. The patient and every member of our team are essential in achieving an optimum treatment plan.
Why can’t a single surgery “cure” my lymphedema? Why do I need the rest of the treatment?
Lymphedema is a chronic disease process. Since 2005, Dr. Granzow has seen and treated patients with different stages of the disease with a wide variation of symptoms and issues. He knows the possibilities and limits of the surgeries and when to recommend them. He understands that no single type of surgery or therapy is effective for all patients, and the treatment and surgery must be individualized carefully for each and every patient to achieve the maximum benefit. Many of Dr. Granzow’s patients have been able to achieve complete reductions in volume or therapy and compression. The best results have been achieved when the patient continues to maintain a relationship with their home therapist and continues to take careful lymphedema precautions when performing activities such as flying, gardening and other at-risk activities. He and his team also know how to optimize important items like diet and exercise.
Why should I go to a lymphedema surgeon who is trained and experienced with performing different types of lymphedema surgery?
There is no “one size fits all” solution for lymphedema patients. Patients suffering from lymphedema have varied symptoms, degrees of severity and progression of the disease. The characteristics of each patient’s lymphatic system also are different. In other words, a particular lymphedema surgery may be suited for one patient but not another patient. Dr. Granzow created the comprehensive FLO System® in order to optimize specific and individualized lymphedema surgery and treatment to optimize results for all stages of lymphedema. He is board-certified, trained and experienced in performing all three types of lymphedema surgeries: VLNT, LVA and SAPLSM. He developed a comprehensive lymphedema treatment system that fully integrates lymphedema surgeries and lymphedema therapy to treat all stages of lymphedema.
Will insurance pay for my lymphedema surgery?
We spend tremendous time and effort with each patient to maximize their insurance coverage. Our team, led by our Director of Patient Advocacy, has a tremendous success rate in achieving insurance coverage for our patients, regardless of their ability to pay. Click here for more information about our Director of Patient Advocacy.
Would my previous history of radiation therapy or lymph node dissection surgery prevent me from having success with lymphedema surgery?
Most of Dr. Granzow’s patients developed their lymphedema symptoms following radiation therapy, lymph node dissection surgery or both. He has extensive experience with patients that have had these treatments. These prior operations will not prevent you from having success with lymphedema surgery.
What is the risk of infection after lymphedema surgery?
Lymphedema surgeries, just like all other low-risk surgeries, carry the small risk of postoperative infection. In fact, the risk of dangerous cellulitis infections dramatically decreases following lymphedema surgery as has been described in our lymphedema publications.
What type of lymphedema surgery is appropriate for me?
Each patient’s lymphedema history and symptoms are different and must be evaluated individually by Dr. Granzow and his team. Patients with stage 1, fluid-predominant lymphedema tend to benefit most from lymphedema therapy, VLNT and LVA. Patients with stage 2, solid-predominant lymphedema tend to benefit more from SAPLSM. Dr. Granzow will evaluate your individual case and make specific recommendations about your options at your visit.
Is it too late for me to get lymphedema surgery?
Your lymphedema symptoms, rather than the time course of the disease will most influence the course of treatment. Dr. Granzow has had tremendous success with patients even with long histories of lymphedema.
Does lymphatic fluid create adipose tissue (fat)?
Lymphedema fluid is toxic and inflammatory and causes the pathologic fat and proteins to appear over time. Patients with permanent deposits of such fat and proteins have at least stage 2 lymphedema.
Are Lymphedema surgeries more successful in arms than legs?
Due to gravity, swelling in the body tends to accumulate much more in the legs than in the arms for almost all medical conditions, including lymphedema. Therefore, the lymphedema swelling is typically is easier to treat in arms than in legs.
Can early intervention prevent the deposition of lymphedema fat and solids?
Yes, the chances of lymphedema swelling progressing from fluid-predominant to solid-predominant stage can be reduced with early intervention such as proper lymphedema therapy, compression, and appropriately selected surgery.
Do you treat patients with primary or congenital lymphedema using the FLO System®?
Yes! We have successfully treated many patients with congenital lymphedema, even if their disease has progressed to stage 2 lymphedema. Click here for an example
Am I a candidate for surgery if I am severely overweight?
Patients who are severely overweight tend to have higher surgical risks and less favorable surgical outcome with any type of surgery, including lymphedema surgery. Excess weight also worsens and can even cause lymphedema. In general, we do not recommend lymphedema surgery for severely overweight patients and recommend weight loss first as the lymphedema can tremendously improve with weight loss alone.
What do all the letters behind Dr. Granzow’s name mean?
- MPH: standing for “Master of Public Health”, this is a professional master’s degree awarded for public health studies. The MPH is typically a 1-2 year program, with many of its students already possessing an advanced medical degree. Dr. Granzow’s MPH includes an additional specialization in Health Systems Management.
- FACS: standing for “Fellow, American College of Surgeons”, this designation indicates that Dr. Granzow’s professional qualifications, education and training, ethical conduct, and surgical competence have passed a rigorous evaluation and are consistent with the high standards required by the College of Surgeons. The American College of Surgeons, which is the largest organization of surgeons in the world, evaluates eligibility of applicants by investigating their entire surgical practice, ensuring, among other things, a certification by an American Surgical Specialty Board which is appropriate to the applicant’s specialty practice and ethical fitness and professional proficiency as determined by an appropriate College Credentials Committee.
- AOA: Alpha Omega Alpha (AOA) is the only national honor medical society dedicated to recognizing and enhancing academic excellence, professionalism, service, and leadership within the medical profession. Membership in this society is granted only to the top students in a given medical school class year at graduation. Dr. Granzow graduated in the top 10% of his medical school class.
Vascularized Lymph Node Transfer (VLNT) Questions
Do you ever use more than one lymph node donor site during the VLNT procedure?
We do not use more than one donor site during a single procedure. Dr. Granzow has found that the VLNT procedures have an excellent success rate using one donor site and prefers to leave additional donor sites untouched. This reduces overall surgical risk and preserves additional donor sites should they ever be needed in the future.
I have read that, on average, lymph node transfer procedures are successful in only 30% of patients.
No surgery, including lymphedema surgery, can produce a good outcome if used in the wrong patient at the wrong time. This is why Dr. Granzow developed the FLO System®, which produces the optimal treatments for patients with all stages of lymphedema. While other lymphedema treatment facilities may only offer a single procedure, such as lymph node transfer, for all patients, we offer a much larger range of surgical procedures that can effectively address the lymphedema presentations of a much wider range of patients. This allows us to achieve an average overall reduction of excess volume of approximately 86% in legs and 111% in arms and statistically significant reductions in the needs for lymphedema therapy and compression garment use. These results are reported in our studies using the FLO System® of procedures and therapy. This is well above the average values of the medical literature when taken together as a whole. Click here for an example.
In a vascularized lymph node transfer (VLNT) surgery, would taking lymph nodes from a different part of the body cause lymphedema symptoms in that part of the body?
There has been fear that moving lymph nodes from one part of the body can cause lymphedema symptoms in the donor area. Indeed, there have been reports in medical literature of lymphedema at the donor site for multiple areas, including areas previously thought to be “safe” like the supraclavicular (neck) area. Dr. Granzow performs reverse lymphatic mapping specifically to identify those lymph nodes that are most important to drain the donor site to avoid injuring them in a surgery. Reverse lymphatic mapping and careful selection of lymph node tissue by Dr. Granzow during vascularized lymph node transfers is critical to minimize surgical risk and maximize the outcomes of the procedure.
Is it possible to use lymph nodes donated from another person for lymph node transfer (VLNT)?
Multiple issues related to rejection of transplanted organs currently make lymph node transfer from another individual unavailable as an option at this time. Currently, Dr. Granzow uses only a patient’s own lymph nodes for vascularized lymph node transfers.
I have seen reports of vascularized lymph node transfer (VLNT) being performed to the wrist or ankle. Does Dr. Granzow perform this form of VLNT surgery?
For many reasons, Dr. Granzow finds it unnecessary to place a VLNT flap to the wrist or ankle. He has achieved excellent results by moving the lymph nodes to more hidden areas where lymphatic drainage is also increased. This means that the surgery sites tend to be to areas such as the axilla (armpit) or thigh as a first choice, rather than the wrist or ankle.
Suction Assisted Protein LipectomySM (SAPLSM) Questions
What kind of volume reduction can I expect to experience after SAPLSM?
Our goal is to achieve a volume reduction in the patient’s lymphedema arm or leg so that it approximates the size of a normal arm or leg. While each patient is different and no guarantee can be made as to a particular percentage of reduction, we have found an average overall reduction of excess volume of approximately 86% in legs and 111% in arms in our published medical studies.
Why do you prefer flat knit compression garments rather than adjustable bandaging devices or bandaging?
While it is possible to use adjustable bandaging devices or bandaging, we have found that custom-fit, flat knit, compression garments are easier to use and better tolerated than bandaging over the long term. As the size of the arm or leg decreases after SAPLSM surgery, the comfort and effectiveness of custom flat knit compression garments continues to improve. This decreases the amount of care and effort required for each patient.
Can lymphedema swelling return after the SAPLSM surgery?
We prevent the re-accumulation of the lymphedema fluid after SAPLSM surgery with a specialized course of lymphedema therapy and compression garment use. These garments are specially fitted for each patient. The continuous use of custom fit, flat knit compression garments is needed for all stage 1 and stage 2 lymphedema patients to prevent progression of their disease. This does not change after SAPLSM surgery, although the compression and maintenance become easier for almost all patients after the SAPLSM surgery healing is complete. The requirement for continuous compression can be reduced significantly with a carefully planned VLNT and/or possibly LVA procedure performed after the arm or leg has healed and downstaged from stage 2 to stage 1 following SAPLSM.
Can fat reaccumulate in the arms or legs after SAPLSM?
The removal of fat and proteins with SAPLSM surgery is permanent and this does not reaccumulate with proper postoperative therapy and compression. The therapy and compression needed after SAPLSM surgery is usually less than that required before SAPLSM surgery.
How do you minimize the risk of damaging the lymphatic vessels during a SAPLSM procedure?
Specialized training, careful technique and extensive experience with the surgery allow Dr. Granzow to reduce the risk of damage to lymphatics during SAPLSM. In fact, Dr. Granzow’s published medical studies have shown that the lymphatics are not further damaged by SAPLSM. In our experience, lymphatic function actually appears to have improved after the reduction of the excess pathologic fat and proteinaceous solids that are removed by SAPLSM. Most important, the risk of cellulitis and infection decreases significantly after SAPLSM. Blood flow to the skin of the affected arm or leg has also been shown to improve after surgery.
Can you treat patients that have both lipedema (lipoedema) and also lymphedema (also called lipo-lymphedema) with the SAPLSM procedure?
Yes. The SAPLSM procedure can be very effective in such cases and Dr. Granzow has significant experience with this. The type of surgery and requirement for therapy will vary among individual patients.
What happens to my skin after excess volumes of lymphedema solids have been removed? Does it need to be resected?
We have found that the excess skin has contracted remarkably well in our lymphedema patients. Dr. Granzow’s SAPLSM procedure makes resection, or cutting out, of excess skin unnecessary in almost all of his SAPLSM patients. Please see our gallery for patient photos.
Are there any preliminary tests that should take place prior to an evaluation in person with Dr. Granzow?
Dr. Granzow may use specialized studies, such as lymphoscintigraphy, to help him assess the function of a patient’s lymphatic system. His extensive experience treating lymphedema patients will allow him to choose the best imaging and other tests needed for each patient’s specific circumstances.
Lymphaticovenous Anastomosis (LVA) Questions
I have heard that the small connections in lymphaticovenous anastomosis surgery (LVA) may work initially but fail over time. Is that true?
Dr. Granzow has found excellent long-term results with his LVA surgeries and has performed hundreds of procedures. LVA surgery requires the use of supermicrosurgery, with most vessels that are connected being less than 1 mm in diameter. The method used and the training and experience of the surgeon are extremely important for the success of this procedure, and will vary from surgeon to surgeon and center to center.
For more information on all lymphedema treatments options or to schedule a consultation with Dr. Granzow, contact our Center of Excellence today at (310) 882-6261.