Lipedema is a chronic disease that occurs almost exclusively in females. It affects the adipose (fatty/fat) tissues and is characterized by bilateral, symmetrical fatty tissue excess, mainly in the hip area, upper and lower legs, and sometimes the arms. The condition is characterized by the following:
It is an inherited condition
It occurs in females of all sizes – Obese to underweight
It presents as excess deposit of fat in unusual and particular patterns
Unlike regular fat, lipedema fat cannot be eliminated through exercise and diet
Lipedema Symptoms and Signs
Age of onset is usually puberty, pregnancy, menopause
Upper body slender with large lower body – 2 body syndrome
Symmetrical Presentation
Pain in soft tissue; hypersensitivity to touch
Pain when walking or sitting
Easy bruising
Accumulation of lipedemic fat from waist to knees or fat pads above, inside and below knees, outer thigh, and inside and outside of ankle
Patients must complete MLD and CDT with compression prior to surgery to complete decongestion of lipedema tissue
The majority of patients have a significant reduction of clinical lipedema symptoms and experience immediate relief of pain, edema, bruising, improved mobility, improved quality of life
Reduced need for conservative treatment after liposuction
Surgical Considerations
Patients with lipedema often have other medical conditions that put them at higher risk for complications. Therefore, all efforts must be made to minimize the risk of complications.
Lymph sparing liposuction with generous tumescent technique that avoids general anesthesia
Generally not more than 5.0 liters of total volume aspirate should be removed in one surgical procedure
Generally not more than 5% – 8% of total body surface area should be treated in one surgical procedure
Small liposuction cannulas should be used
Surgical technique is very important. Intimate knowledge of the locations and anatomic variations of the lymphatic drainage in the limb or body area that is being treated is crucial
Patients with varicose veins greater than 4.0mm in the treatment area, or with significant underlying venous reflux, should be treated before having lymph sparing liposuction.
Insurance
Reasons why your insurance provider usually does not pay for liposuction:
Lipedema does not have its own ICD-10 diagnosis code
Research for lymph sparing liposuction for lipedema has been performed outside of the US, which is not recognized by most insurance companies
Insurance companies are not convinced liposuction is an effective treatment for lipedema – considered experimental.
The Liposuction Procedure is considered cosmetic and therefore an exclusion on the policy.
Procedure is not a covered benefit for any reason – administrative exclusion.
Insurance Approval
Very long process of rejection and appeals that requires diligence and dedication:
Must prove medical necessity and evidence as to why the exclusion of liposuction should be overturned
Obtain letters of medical necessity from all physicians
Obtain medical records from all providers
Write a letter explaining in great detail how lipedema affects your quality of life, ability to carry out daily tasks, ability to work, and the
– If your insurance is through an employer that is self‐insured work with the HR department to obtain approval.
Research in Which We are Participating:
TREAT Study
Funded by the Lipedema Foundation to study lipedema and Dercum’s Disease
T: Development treatment regimens
R: Research on SAT disorders
E: Develop educational materials
AT: Focus on adipose tissue disorders
Washington University
The purpose of this study is to assess body fat composition and metabolic function in women with lipedema before and after weight loss.
