Areas of Expertise:
Dr. Jay Granzow is an internationally respected lymphedema surgeon. He serves as Professor of Surgery in the Division of Plastic Surgery at the UCLA David Geffen School of Medicine, and Assistant Chief of Plastic Surgery at Harbor-UCLA Medical Center. He is Board Certified both in Plastic Surgery and Head and Neck Surgery.
A pioneer in lymphedema surgery, Dr. Granzow successfully integrated lymphedema therapy with three types of lymphedema surgery including vascularized lymph node transfer (VLNT), lymphaticovenous anastomosis (LVA) and suction assisted protein lipectomy (SAPL). He has published major scientific articles on lymphedema surgery in leading medical journals. Dr. Granzow is a frequent lecturer at U.S. and international conferences, educating patients, therapists and physicians on the latest advances in lymphedema surgery. Dr. Granzow provides lymphedema treatment for patients in his private medical practice located in the Los Angeles area.
I had total reverse shoulder arthoplasty and Dr missed I had lymphedema until it was stage 2 I want to find out if I am a candidate for lymph transfer?
Thank you for your question. Unfortunately, it is not uncommon that physicians fail to notice the signs and symptoms of lymphedema. Many medical schools devote around 1 hour or less of the entire 4-year curriculum to the study of lymphedema.
A thorough evaluation by an experienced lymphedema surgeon and lymphedema therapist is recommended to evaluate for the possibility of a vascularized lymph node transfer (VLNT) or other lymphedema surgery. Your comment that the arm is stage 2 implies that the lymphedema is more advanced and has a significant solid component present. This means that the affected arm does not reduce in size to the size of the opposite, unaffected arm even when proper lymphedema therapy, compression and other conservative (non-surgical) therapy is used to remove the excess lymphedema fluid present. In such cases, VLNT surgery, a procedure which also is designed to remove lymphedema fluid, if used by itself, would not be successful in reducing the volume of the arm to the size of the unaffected arm, although minor improvements in volume and and improvements in symptoms may occur.
Instead, for lymphedema with significant solid component present, suction assisted protein lipectomy (SAPL) surgery would first remove the excess lymphedema solids and allow the arm to reduce to the size of the opposite arm. SAPL surgery does not increase or reduce the need for compression garment use. Once healing is complete, VLNT and/or lymphaticovenous anastomosis (LVA) surgeries could be prescribed to further reduce symptoms and the need for compression use and lymphedema therapy.
Can you please let me know what are sucess rates for LVA (lymphaticovenous anastomosis) in case of Primary Lymphedema (1st manifested at the age of 23) in right arm? Do you perform such a surgery? If not, can you please refer me to someone who does. Thanks.
Thank you for your question. Since 2005, I have successfully performed lymphaticovenous anastomosis (LVA) lymphedema surgery in either primary or secondary lymphedema patients.
In my experience, patients overwhelmingly see improvements in lymphedema symptoms and see significant decreases in the amount of compression and therapy needed after LVA surgeries. The exact amount of improvement will vary from patient to patient. Patients with congenital/primary lymphedema often show tremendous improvements after LVA, often similar as patients with secondary lymphedema. LVA surgeries also are generally the least invasive and have the quickest recoveries compared to other lymphedema surgeries.
I have Stage 3 lymphedema in my right leg with serious leaking, pain, mobility issues and near constant cellulitis infections. Amputation seems to offer a better quality of life. Is it a viable solution to amputate the affected limb?
Stage 3 lymphedema as you describe can be extremely debilitating, cause serious health issues and be very difficult to live with.
Amputation would present a very extreme treatment. It may not alleviate all symptoms of lymphedema and my not improve overall quality of life. After amputation, lymphedema may still persist in the remaining part of the leg may and may contribute to significant healing issues after amputation. In addition, the physical functional losses associated with an amputation, especially an above-the-knee amputation, are also significant.
Therefore, I would strongly recommend pursuing all conservative and surgical options before considering this extreme approach to treatment.
I have edema around my breast implant from reconstruction. Could this be made worse if I had them removed or replaced? Could it be caused from the implant itself? I only had one node removed in my mastectomy surgery. The swelling gets worse with weather changes, air pressure.Thank you.
It sounds like you are describing edema or swelling in the skin and soft tissues immediately next to the breast implant, such as the skin and fat of the breast and chest wall rather than having fluid in the implant pocket itself.
Edema may occur in the treated chest wall skin after surgery, especially if the skin and chest wall soft tissues have been treated with radiation therapy need for cancer treatment. In fact, in my experience, previous radiation therapy will be much more likely than lymph node surgery to worsen chest wall swelling and symptoms.
Additional swelling will always occur to some extent after additional surgery, such as removal and replacement of implants. Most of this swelling will resolve over time.
Unfortunately, it is impossible to predict how this swelling will behave. Lymph node removal can increase the chances of worsening swelling over time.
My husband has had lymphedema in both legs for 8 yrs. Developed after back surgery. He weighed 210 lbs .. He is now 410 lbs. What are the courses of action we should take to get weight off him. Should bariatric surgery be a consideration. Thank you
Thank you for your question.
For your husband, the weight issue is separate from the lymphedema issue. For our patients with similar situations we have recommended treatment by a team of caregivers who specialize in treating severely overweight patients. This team will typically include a surgeon specializing in bariatric (weight loss) procedures. The final decision on whether or not to recommend and/or pursue surgery weight loss will rest with the team and the patient.
We have found that increasing patient weight often makes lymphedema symptoms worse and the lymphedema more difficult to treat. Conversely, lymphedema often becomes easier to treat when patients safely decreases a large amount of weight.
I had a body lift with dehiscence complications, I packed Wet to dry for 7 weeks! I have huge abdomen , thighs , buttocks that grows throughout day and horribly uncomfortable. Who or type of doctor do I go to for diagnsis? Is this possible to be in those areas
It sounds like you are describing issues that can occur after “body lift” types of surgery, even when surgery is properly performed. Wound dehiscences can be extensive due in part to the very long incisions and large surface areas involved. This type of swelling swelling is unlikely related to lymphedema.
You would be best served by continuing care with the surgeon who performed the body lift, who should be familiar with such issues.
Hi DR Granzow As vascular surgeon ,I met in my clinic children below 5 years and complaining from different forms of primary lymphedema ( localized to the feet or leg ,sometimes involve whole limb,).my questions are : 1- what is the best investigation tool ( e.g.NIRFLI,MRI ...)? 2-do you prefer certain age for intervention i.e. postpone surgery untill growing up? 3- what are kind of surgery do these children need( e.g.SAPL,VLNT)&are these surgeries different from those in Adult? Thanks in advance A.SAWABY
The patients that I treat are primarily adult patients but I have come across children and teenagers who have primary lymphedema. I would consider MRI of the affected extremity and adjacent torso to better characterize the limb and also rule out proximal pathology that may be contributing to the swelling.
An indocyanine green imaging study in both the affected limb and the unaffected side would also be very helpful. I would recommend having this study also performed with the child under anesthesia, as the injections can be difficult to tolerate.
I was recently diagnosed with RT leg lymphedema after a single SLNB in my groin. I am learning to manage with daily compression use and the flexitouch, but am only 34 and expect to need surgical and/or other therapeutic treatment in the future due to the progressive nature of the condition and duration. As many patients do I seek tips, tricks, and community through other lymphedema patients on social media. A patient recently posted that she is having VLNT and surgeons do not want you to use the compression pump before or after. Is that accurate? If so, immediately before surgery or ever? Can you explain why? Thank you.
The compression pump can be effective for some patients in moving lymphedema fluid and helping manage the fluid part of the lymphedema volume excess. Other modalities that also move fluid are manual lymphatic drainage (MLD), compression garments, and microsurgery such as vascularized lymph node transfer (VLNT) or lymphaticovenous anastomosis (LVA).
For my patients, I have no issue with compression pump use before surgery. For VLNT surgery, I typically allow my patients to use their compression pump again 6 weeks or so after surgery.
Please keep in mind that treatments I mentioned above (MLD, VLNT and LVA surgeries) are not be effective in reducing the permanent solid portion of lymphedema swelling. Such solid swelling has also been described as “non-pitting”. This solid excess is best treated with SAPL lymphedema surgery, prior to repairing the defect in your lymphatic system using microsurgeries such as VLNT or LVA surgeries.
DEAR Dr.Jay I am interested in lymphedema surgery. If you allow me to ask you about SAPL technique : 1_Which cannula type you prefer for liposuction ? 2_What is your solution for humping of forefoot (long lasting CDT or liposuction)? 3_what is the max. amount of liposuction per limb? 4_in st.II lymphedema,when you decide to liposuc? Thanks in advance A.Sawaby
Thank you for the interest in SAPL surgery. I believe a bit of background will give more insight into the answers.
Lymphedema swelling comes in 2 forms – fluid swelling and solid swelling. Fluid swelling occurs first, and is caused by accumulation of the inflammatory lymph fluid. This can be treated with modalities that move fluid and include conservative treatments such as compression garments, manual lymphatic drainage and compression pumps. This fluid in most people tends to collect more in the feet, ankles and lower legs due to the effects of gravity. Swelling in the foot tends to be fluid, and typically is best addressed in this way. Microsurgery procedures such as LVA or VLNT also are effective in moving fluid.
Over time, the inflammation caused by this fluid leads to damage of the surrounding structures and permanent deposits of solids. These can be quite thick, and cannot be removed with conservative treatments or LVA/VLNT surgery.
I find that an integrated approach to lymphedema treatment consistently yields the best results. Therefore I prefer initially to use proper lymphedema therapy to reduce the fluid volume excess first, and then use SAPL surgery to remove the remaining solids to allow the limb to approximate its normal size. My experience is that few patients have sufficient excess solid present in the foot and ankle to require SAPL surgery in these areas.
SAPL surgery can be used for solids that have been present for both short or very long times. I have successfully treated patients whose lymphedema solids were present for almost 50 years. To remove the solids, a blunt, custom-made cannula that is much larger and longer than average is used. While the maximum amount of solids that can be removed varies from person to person, in almost all cases I have been able to treat an entire leg in one surgery.
It is important to note that SAPL surgery is very different from cosmetic liposuction. This is due to significant differences in the technique used, such as the use of a tourniquet during SAPL, which can greatly increase safety and also the amounts of volume that can be removed when properly applied.
How do I go about finding a doctor to diagnose and support me in my struggle with lipedema or lymphedema? My primary care said she read some articles and thought it was Lymphedema. She referred me to two different vascular surgeons, both found insufficient veins and seemed gleefully happy that I would qualify for surgery...however neither led me to believe this would be anything more than short-term relief and neither made me feel this would result in significant improvement. Instead I went to an OT who has helped me a great deal. Her therapy combined with compression stockings that were made specifically for me has helped somewhat. Looking long-term, I would love to find a knowledgeable physician to guide me and support me in making decisions to support my journey. What type of specialist would this be? Are there any in New England? Thank you,
This is a question often asked by patients with lipedema or lymphedema. Unfortunately, many health providers are not familiar with these conditions to provide adequate guidance to patients. In fact, most physicians receive little to no teaching about lymphedema during their entire 4-year medical education. Patients often report that they feel they have more knowledge than their primary care physicians about their condition.
We find that patients who are successful in managing their conditions have a team of knowledgeable medical professionals who care for them. For instance, this team could be comprised of a primary care physician who is open-minded and want to learn about lymphedema or lipedema, a certified lymphedema therapist (CLT) who provides ongoing therapy for the patient, and perhaps a surgeon who has expertise in lymphedema or lipedema.