Suction Assisted Protein LipectomySM (SAPLSM) for Advanced Lymphedema of the Arm or Leg

Suction Assisted Protein LipectomySM (SAPLSM) surgery is part of Dr. Granzow’s comprehensive FLO System®  lymphedema program. Since 2010, Dr. Granzow has been performing his unique SAPLSM surgeries to achieve safe and dramatic reductions of the affected arms or legs in hundreds of patients with advanced, stage 2 lymphedema.

SAPLSM lymphedema surgery performed by Dr. Granzow achieves a consistent average overall reduction of excess volume of approximately 86% in legs and 111% in arms and effectively normalize the size of the affected arm or leg in most patients. Dr. Granzow has published these impressive results in prestigious medical journals. Such consistent volume reductions are far superior to those possible with other surgery or treatment methods such as VLNT or LVA in patients with stage 2 lymphedema. Patients experience permanent volume reductions with SAPLSM surgery as part of the FLO System® treatment program.

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Before
After

Patient with a prior 17-year history of non-pitting lymphedema of the right arm, treated with SAPLSM. After treatment, the affected right arm is now slightly smaller than the unaffected left side.

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Before
After

34 year old patient with a 17-year history of congenital/spontaneous lymphedema of the left leg treated with SAPLSM. After treatment, the affected left leg is now smaller than the unaffected right leg.


Innovative 2-Phase Method to Reduce Both Lymphedema Volume and Symptoms

Dr. Granzow has pioneered the 2-phase combination of SAPLSM surgery with VLNT and LVA surgeries to achieve both volume reduction and also significant reductions in compression garment use and lymphedema therapy. He was the first surgeon to successfully perform SAPLSM with subsequent VLNT and LVA surgeries for the same patient to normalize the size of the arm or leg and also reduce the requirement for postoperative garment use and lymphedema therapy.

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Before
After

Patient 18 Months After Lymphatic Liposuction and 7 Months After Vascularized Lymph Node Transfer.
A volume reduction of over 80% was achieved and a compression garment is no longer worn during the day. This reduction has been maintained for almost 10 years after surgery.


Dr. Granzow in Sweden with
Dr. Hakan Brorson.

Why SAPLSM Surgery for Stage 2 Lymphedema Patients?

VLNT and LVA surgeries by themselves cannot significantly reduce the solid volume excess found in late, stage 2, lymphedema. Dr. Granzow performs his unique SAPLSM lymphedema surgery to remove these solids permanently. In these patients, the lymphedema disease process has progressed to such an extent that the lymphatic system has broken down and permanent solids have accumulated. In many cases, the affected arm or leg may feel soft, and careful examination by a trained expert may be required to differentiate soft solid from soft fluid in the affected area.


SAPLSM is NOT Cosmetic Liposuction

It is critical to note that SAPLSM is different from cosmetic liposuction techniques. The indications, equipment, therapy integration before, during and after surgery and surgeon training and experience are all unique. A team-based approach with an experienced surgeon and trained lymphedema therapist is required.

SAPLSM is Safe

Example of material removed during SAPLSM surgery. The volume and character of the pathologic fluids which accumulate in stage 2 lymphedema are different than regular fat removed with cosmetic liposuction.

Dr. Granzow’s SAPLSM lymphedema surgery has been proven to produce safe and consistent results and the research results are published in prominent medical journals. The lymphatics in the arm or leg are not damaged by the surgery. In fact, the reduction of excess fats and pathologic solids decreases inflammation and improves the lymphatic drainage of the limb and considerably improves the management of the affected areas.  The need for compression garment use in SAPLSM patients does not increase after Dr. Granzow’s SAPLSM surgery.

Peer-reviewed papers in the medical literature have shown that SAPLSM has been shown to significantly decrease the incidence of surgical infections and cellulitis after surgery. Studies specifically looking at the lymphatic system before and after SAPLSM also have shown that SAPLSM does not appear to further damage the already damaged lymphatics in an arm or leg affected by lymphedema.

SAPLSM and Obesity

Massive obesity on its own has been shown to cause lymphedema, and multiple theories exist to explain the decreased lymphatic function in severely overweight arms and legs. Significantly overweight patients are not appropriate surgical candidates for lymphedema surgery. However, weight loss itself has been shown to improve such lymphedema.

If you would like more information about SAPLSM surgery, please contact our Center of Excellence at (310) 882-6261 to schedule a consultation.

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