I offer my clients lymphatic drainage massage after a tummy tuck. Lymphatic drainage massage helps with bruising, swelling and drains the lymph nodes in the area of surgery. After surgery patients are left with drains that are attached to the skin via a small tube. By massaging these drains and surrounding tissues you facilitate draining of excess fluids and promote recovery.
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Lymphatic Drainage After Tummy Tuck
Manual Lymphatic Drainage in Postoperative Abdominoplasty With Core Liposuction Patients
Abstract
Manual lymphatic drainage (MLD) performed by lymphatic massage, in the postoperative period after abdominoplasty with core liposuction, may promote a faster resolution of edema. The purpose of this study was to determine the benefits of MLD by assessing the amount of edema at 6 and 8 weeks after abdominoplasty with core liposuction in patients who did or did not receive MLD for 3 weeks. The study used a prospective, comparative design. A total of 20 women aged 30 to 60 years, who underwent an abdominoplasty and core liposuction, were recruited from 2 clinics. Participants were divided into 2 equal groups based on clinic location. All participants wore a standard compression garment for 8 weeks after surgery. Starting at 6 weeks after surgery, the treatment group was treated by a certified lymphedema specialist twice a week for 3 weeks (6 visits). At 6 and 8 weeks after surgery, the waist circumferences of all participants were measured in 3 locations: at the navel, 3 cm above the navel, and 3 cm below the nave. Data from the 2 groups were compared to determine the change in edema. The mean age of participants was 41.6 years (range = 32-59 years) in the treatment group and 40.8 years (range = 30-59 years) in the control group. The mean (SD) reduction in edema between weeks 6 and 8 in the treatment group was 9.8 cm; 1 participant lost 18.2 cm during that period. The mean (SD) reduction in edema between weeks 6 and 8 in the control group was 6.6 cm; a few participants lost 12.0 cm during that period. No differences in mean reductions were found between groups (P = .11). No differences were found between groups based on clinic location (P = .84). Our results suggested that receiving MLD after abdominoplasty and core liposuction reduced edema more than the standard compressive garments, but not by a statistically significant amount. Furthermore, differences in the study groups were not dependent on clinic location.
Introduction
Abdominoplasty, with or without liposuction, is one of the most frequently performed aesthetic procedures in the world.1 It is the sixth most common cosmetic procedure performed each year, and an estimated 800 000 people or more have this procedure annually.1,2 Abdominoplasty improves one’s contour by removing excess skin and fat from the body.1 The procedure can also improve the body’s shape by tightening the abdominal wall.1 Some edema after surgery is anticipated as part of the normal healing reaction. In surgeries such as abdominoplasty, there are many factors contributing to postoperative edema that persists beyond the acute recovery phase. For example, the superficial lymphatic system can be damaged during liposuction by the cannula strokes when removing the adipose tissue.3 The lymphatic system can be further damaged when the abdominal skin is elevated, which leads to a discontinuity in the lymphatic system, and by the low abdominal incision, which transects the lymphatic channels.3 Without the lymphatic drainage system, excess fluid, known as lymphedema, results. This excess in fluid increases the inflammatory response that the tissue is exposed to and can, in turn, lead to skin fibrosis, accumulation of adipose tissue, and further accumulation of fluid.3 In surgical patients, particularly cosmetic surgical patients, this excess and persistent fluid can negatively impact comfort, function, and quality of life.4
Manual lymphatic drainage (MLD), which is a type of hands-on massage therapy to stimulate the lymphatic system, has been well studied for its effects on edema in breast cancer patients who have undergone mastectomy with or without postoperative radiation therapy.5 These studies have shown that light massage during the initial postoperative period can help accelerate the removal excess fluid, which in turn decreases the recovery time and leads to improved patient satisfaction and quality of life.5 Manual lymphatic drainage stimulates the lymphatic system to increase the circulation of the lymphatic tissue and system throughout the body.6,7 This increase in the circulation of lymphatic material expedites the removal of wastes within the bodies tissues.6,7 Manual lymphatic drainage also enhances the body’s fluid dynamics, which facilitates a reduction in a patient’s edema.6,7 It can also minimize the sympathetic nervous system responses while increasing the parasympathetic tone, which allows the body to be in a nonstressed state.6,7
To our knowledge, little research has investigated the effects of MLD in cosmetic surgery patients, especially in patients who have undergone abdominoplasty and aggressive core liposuction, which includes liposuction to the back, flanks, hips, and abdomen. This core liposuction is more extensive than the Avelar or Saldanha abdominoplasty techniques which include more of a selective liposuction to the abdomen, thus leaving much of the abdominal lymphatics intact. Performance of core liposuction (liposuction to the upper and lower abdomen, back, hips, flanks) will tend to disrupt the lymphatic channels to a greater extent than other abdominoplasty techniques, thus leaving patients with greater amounts of edema during the recovery periods. Therefore, the purpose of this study was to determine the benefits of MLD by assessing the amount of edema at 6 and 8 weeks after abdominoplasty with core liposuction in patients who did or did not receive MLD for 3 weeks.
Methods
This study used a prospective, comparative study design. In total, 20 women aged 30 to 60 years who underwent an abdominoplasty and core liposuction at 2 different locations were recruited to participate in this study. Potential participants had to have postoperative edema and were excluded if MLD was contraindicated. The study received institutional review board (IRB) approval from the local institutional (Freeman Heath Systems) review committee on February 16, 2018, and informed consent was obtained from eligible and willing participants prior to any study interventions.
Participants were divided into 2 equal groups (treatment and control) based on clinic location. Both groups received the current standard postoperative care for this procedure, which included wearing a standard compression garment (compression = 21 mmHg) 24 hours a day (except for showering) for 8 weeks after surgery. The control group only wore the compression garment. All participants were followed for study outcomes, objectives, and adverse events.
Starting at 6 weeks after surgery, the treatment group was treated by a certified lymphedema specialist twice a week for 3 weeks (postoperative weeks 6, 7, and 8). They were also given instructions for home exercises, using a similar massage technique as indicated by the specialist, during those 6 visits. The MLD was performed using a technique called the Vodder Method, which uses circular movement with increases and decreases of pressure on the treated area.8 The changes in the pressure generate a pumping effect, which encourages lymph movement throughout the tissue.8 A typical treatment session for this study included stimulation of the bilateral axillary lymph nodes and inguinal lymph nodes. The superficial lymphatic system proximal to the surgical site (abdomen, chest, and back) was then treated. Each patient was instructed on diaphragmatic breathing to stimulate the thoracic duct and the deep lymphatic system.
At 6 and 8 weeks after surgery, the waist circumferences of all participants were measured in 3 locations: at the nave, 3 cm above the navel, and 3 cm below the navel. For the treatment group, waist circumferences were measured and recorded at the second MLD visit of the week. For the control group, participants went to the clinic to have their waist circumferences measured and recorded at week 6 and then again at week 8.
Data were summarized using mean (SD). A linear mixed model was used to assess the mean change in edema from week 6 to week 8 between groups overall and at each location. Random intercepts were used to account for correlation among repeated measurements on the same patient, specifically for time and location. Analyses were performed using SAS version 9.4 (SAS Institute Inc, Cary, North Carolina). A P < .05 was considered statistically significant.
Results
Of the 20 women who participated in this study, the mean (SD) age was 41.8 (8.37) years (range = 32-59 years) in the treatment group and 40.8 (9.39) years (range = 30-59 years) in the control group. The mean (SD) aspirate volume for the treatment group was 5.6 L (1.35) and the mean (SD) aspirate volume for the control group was 5.1 L (1.3). The amount of tissue removed per patient was not specifically recorded. The mean, overall reduction in edema between weeks 6 and 8 in the treatment group was 9.8 (4.22) cm (Table 1); 1 participant lost 18.2 cm during that period. The mean, overall reduction in edema between weeks 6 and 8 in the control group was 6.8 (3.6) cm; a few participants lost 12.0 cm during that period (Table 2). Most reductions were found 3 cm below the navel; participants lost an average of 4.3 cm in the treatment group and 3.6 cm in the control group (Table 3). Although participants in the treatment group had larger reductions in edema, no differences in the mean reductions were found between groups (P = .11; Figures 1–3). No differences were found between groups based on clinic location (P = .84).
Table 1. Amount of Edema Lost in the Treatment Group at the End of Week 8.
Table 2. Amount of Edema Lost in the Control Group at the End of Week 8.
Table 3. Average Edema Present (in cm).
Figure 1. Average centimeter lost 3 cm above the navel.
Figure 2. Average centimeter lost at the navel.
Figure 3. Average centimeter lost 3 cm below the navel.
Discussion
To our knowledge, few studies have investigated the effects of lymphatic massage for the reduction of postoperative edema in patients undergoing cosmetic surgery, such as abdominoplasty. However, this type of hands-on technique to reduce edema after surgery has been widely studied in breast cancer patients who have undergone mastectomy.5 Results of this study suggested that receiving MLD postoperatively reduced the amount of edema more than standard compression garments, but differences in the amount of edema reduction were not statistically significant between study groups. Although these results mostly agree with previous research,5 more research is necessary.
This study had several limitations. The lack of statistical significance between groups suggested our sample size was not large enough. Furthermore, if we had included MLD earlier in the postoperative period, the longer period of treatment may have been more beneficial for observing differences. This study included 2 clinic locations, so 2 different surgeons performed the procedures. Although we found no statistically significant differences between locations, it is possible there were differences because of the different surgeons.
Future studies should include larger sample sizes and longer treatment periods. Researchers should also consider comparing quality-of-life scores between these groups. Although we found no statistically significant differences in reduction of edema between groups, it is possible that those who had MLD had improved pain and quality of life scores.
Conclusion
Results of the current prospective, comparative study suggested that receiving MLD after abdominoplasty with core liposuction caused a greater reduction in edema than standard compression garments alone. However, this difference was not statistically significant and did not seem dependent on clinic location. Despite this lack of significance, our results are still promising. Future studies should be conducted to identify whether the length of MLD or whether starting MLD earlier in the postoperative period would better distinguish between these 2 groups.
Benefits of Lymphatic Massage after Cosmetic Surgery
After you have plastic surgery, particularly a body procedure like a tummy tuck, liposuction, or a mommy makeover, you want to heal as quickly as possible. You want to feel better so you can get back to your daily routine, but you also are excited to see the results of your procedure more quickly. While rest, gentle activity, and following your post-op instructions are key, lymphatic drainage massage can accelerate your recovery period. Dr. Ortiz, a board-certified plastic surgeon in Raleigh, is sharing what lymphatic massage is and how it can benefit you after cosmetic surgery.
What Is Lymphatic Massage?
First, let’s look at the lymphatic system and what it does to better understand how the massage works. The lymphatic system is the system of tissues, vessels, and organs that work in conjunction to maintain fluid levels in our body, support immune function, and keep blood circulating. The system carries lymph, a clear fluid that contains proteins, waste, fat cells, and metabolized cells through the body which is filtered through the lymph nodes. Waste is removed from the body as clean lymph circulates back through. When the lymphatic system isn’t moving lymph through the body properly, excess fluid in the body builds up, causing edema and creating a puffy, uncomfortable look and feel.
Lymphatic drainage massage was developed to treat lymphedema, a condition of accumulated fluid within the body that often develops after removing lymph nodes. A trained massage therapist can manually massage the body in a way to push lymph through the body, breaking up areas of swelling and reducing excess fluid in the body.
Benefits of Manual Lymphatic Drainage
Your lymphatic system is key to healing, regenerating tissues, and removing toxins from the body. When the body has experienced stress, such as fighting off illness, healing from an infection, or experiencing emotional stress, the lymphatic system can slow down. Manual lymphatic massage helps “re-start” the system of moving lymph through the body and can provide a variety of benefits, including:
- More efficient healing from illness, injury, or surgery
- Supports relaxation and relieves stress
- Reduces scar formation by boosting healing responses
- Removes excess water and metabolic waste from the tissues in the body
- Reduces swelling and fluid retention
- Improves skin quality and provides a more vibrant appearance
Why Is Lymphatic Massage Important After Cosmetic Surgery?
One of the side effects of cosmetic surgery is swelling. This is a normal inflammatory response and a part of the healing process as fluid rushes to the area to nourish it with white blood cells. Body procedures, particularly tummy tucks and liposuction, often cause additional swelling as excess fluid and fat cells will harden within a few weeks of surgery.
Lymphatic massage helps to move the fluid that’s built up and allows it to move back into the lymphatic passages where excess waste and fluid can be flushed from the body. This prevents fibrosis, which is the development of thick, fibrous scar tissue under the skin as well as reduces swelling and bruising. Many doctors, including Dr. Ortiz, highly recommend lymphatic drainage after surgery for both their patients’ comfort as well as to help them get the best possible results after their procedure.
Schedule a Consultation for Cosmetic Surgery in Raleigh Today
At North Raleigh Plastic Surgery, we are dedicated to providing you with the best possible experience from your first consultation through your healing process. That’s why we are proud to welcome Sheila Master, LMBT to our team. Sheila graduated from the Southeastern School for Neuromuscular and Massage Therapy in 2000 and has been practicing lymphatic massage since 2006. We are excited to now offer lymphatic drainage massage to our patients to improve their recovery and help them look and feel their best more quickly.