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Topic: Liposuction / Flying Squirrel surgery

Forum: Lymphedema —

Talk with other about how to lower your risk of lymphedema and how to manage it if you've been diagnosed.

Posted on: Nov 29, 2020 11:08PM

Linda2119 wrote:

Hi,

I recently saw Dr. Chen for an ICG, hoping I'd be a candidate for LVA or lymph vessel transfer. But my lymphedema has progressed to the solid predominant stage. He is recommending his "flying squirrel" liposuction surgery.

Has anyone had liposuction performed for their lymphedema? I'd love to hear your results.

From what I understand, one advantage of the liposuction is that you see results right away. And Dr. Chen suggests that it returns you to Stage I or early Stage II lymphedema.

Disadvantages - recovery and one arm being smaller than the other.

I'm hoping someone can give me some feedback.

Gratefully,

Linda

Dx 10/5/2017, DCIS/IDC, Left, 2cm, Stage IIIC, Grade 2, 15/24 nodes, ER+/PR-, HER2- (FISH) Hormonal Therapy 10/18/2017 Arimidex (anastrozole), Faslodex (fulvestrant) Surgery 3/19/2018 Lumpectomy: Left; Lymph node removal: Sentinel, Underarm/Axillary; Reconstruction (left) Chemotherapy 4/18/2018 AC + T (Taxol) Surgery 9/8/2018 Mastectomy: Left; Reconstruction (left): Silicone implant Radiation Therapy 10/24/2018 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy 12/5/2018 Arimidex (anastrozole) Targeted Therapy 12/19/2018 Verzenio
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Nov 30, 2020 12:28PM LivinLife wrote:

I have no idea Linda! Just chiming in with support and well wishes!

with expansive comedo necrosis & weak ER/PR Dx 7/2020, DCIS, Left, 2cm, Stage 0, Grade 3, 0/1 nodes, ER+/PR+ Surgery 8/31/2020 Mastectomy: Left; Prophylactic mastectomy: Right
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Dec 29, 2020 03:23AM MandaLynn wrote:

Hi Linda,

I’m here at Dr Chen’s and today I just got told the same thing. I’m from out of town so I’m scheduled fir the LVA on Wed but he is now suggesting the liposuction.

What did you end up doing?


amanda

Amanda Dx 10/20/2008, ILC, 3cm, Stage IIIA, Grade 2, 4/17 nodes, ER+/PR+, HER2-
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Dec 29, 2020 04:27AM Linda2119 wrote:

Hi, Amanda,

I am waiting for insurance preauthorization, and my husband’s employer is switching us from Anthem to United Healthcare on January 1st, so we have to start all over next week. I trust Dr. Chen and I’m planning to do the surgery when everything comes together.

Let me know what you decide.

Linda

Dx 10/5/2017, DCIS/IDC, Left, 2cm, Stage IIIC, Grade 2, 15/24 nodes, ER+/PR-, HER2- (FISH) Hormonal Therapy 10/18/2017 Arimidex (anastrozole), Faslodex (fulvestrant) Surgery 3/19/2018 Lumpectomy: Left; Lymph node removal: Sentinel, Underarm/Axillary; Reconstruction (left) Chemotherapy 4/18/2018 AC + T (Taxol) Surgery 9/8/2018 Mastectomy: Left; Reconstruction (left): Silicone implant Radiation Therapy 10/24/2018 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy 12/5/2018 Arimidex (anastrozole) Targeted Therapy 12/19/2018 Verzenio
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Jan 12, 2021 12:42AM MandaLynn wrote:

I am currently waiting for insurance authorization too. Think if I do get it, I'll wait until I can get the covid vaccine (hopefully early spring). Let me know if you find out anything.

Thanks,

Amanda

Amanda Dx 10/20/2008, ILC, 3cm, Stage IIIA, Grade 2, 4/17 nodes, ER+/PR+, HER2-
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Apr 3, 2021 11:06PM toomuch wrote:

Hi.

I'm just checking in to see if anyone has gone ahead with the flying squirrel procedure? I developed a solid component to my lymphedema in my upper arm after cellulitis x 3 this year. For the previous 10 years my LE was well controlled. Now my upper arm is more than 3 cm larger than my other arm. Dr. Chen also recommended the flying squirrel procedure for me. I'd love to hear from someone who has had the procedure. I haven't seen any posts about other doctor's suggesting it.


Thanks.

Toomuch

"Every trial endured and weathered in the right spirit makes a soul nobler and stronger than it was before" Dx 7/13/2010, ILC, <1cm, Stage IIA, Grade 2, 2/12 nodes, ER+/PR+, HER2-
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Apr 5, 2021 05:34PM Linda2119 wrote:

Hi, Toomuch,

I am scheduled for surgery with Dr. Chen on June 9. Insurance was a long process for me - I was hoping to be done with the surgery by now.

I believe Amanda was having the surgery done in March - looking forward to hearing from her.

I talked to another patient of my PT who had liposuction surgery done with Dr. Granzow in California. She has been very pleased with the surgery and is glad she did it.

Hope this helps,

Linda

Dx 10/5/2017, DCIS/IDC, Left, 2cm, Stage IIIC, Grade 2, 15/24 nodes, ER+/PR-, HER2- (FISH) Hormonal Therapy 10/18/2017 Arimidex (anastrozole), Faslodex (fulvestrant) Surgery 3/19/2018 Lumpectomy: Left; Lymph node removal: Sentinel, Underarm/Axillary; Reconstruction (left) Chemotherapy 4/18/2018 AC + T (Taxol) Surgery 9/8/2018 Mastectomy: Left; Reconstruction (left): Silicone implant Radiation Therapy 10/24/2018 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy 12/5/2018 Arimidex (anastrozole) Targeted Therapy 12/19/2018 Verzenio
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Apr 6, 2021 11:36AM toomuch wrote:

Thanks Linda!
Please come back and post after your surgery. I’ve been feeling so down about my LE recently. I would love to hear about some positive outcomes



"Every trial endured and weathered in the right spirit makes a soul nobler and stronger than it was before" Dx 7/13/2010, ILC, <1cm, Stage IIA, Grade 2, 2/12 nodes, ER+/PR+, HER2-
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May 26, 2021 04:47AM MandaLynn wrote:

Hi Linda and TooMuch,

I haven't logged in for a while... this year has been so crazy for many reasons. I had my flying squirrel procedure on March 25th and then flew home for recovery. I stayed in arm wraps 24/7 and elevated my arm am/pm for 4 weeks, then continued with wraps for another week or so and am now in 30-40 mmHg flat weave 24/7 along with a hand glove. I have also started using my pneumatic pump again (and see my PT).

It has been quite a journey to say the least! But it has all been worth it and it's in the service of hopefully buying more time until I progress further (years hopefully). I am going to go for another ICG staging this summer and hopefully it will show that I was able to revert to a lower stage (I was a stage III lymphadema -- which surprised me btw because I had only had swelling for a few months.. or so I thought).

I am also scheduled to have the LVA this September. Although that may be on a hold because of insurance issues. (as of right now, Blue Shield has technically "denied" my claim for the liposuction -- even after saying that I didn't need to have pre- authorization for it)!

However, there were a few things that were a challenge for me after surgery. Primarily, I don't think I was prepared enough for what recovery involved. Yes, it's a pain to wrap (but your significant other/friend or whoever will get the hang of it. You will get into a rhythm of washing your wraps and doing dishes with your left hand etc. But, the actual post-op was very difficult for me. And, I think I sort of blocked out what was going to happen and, unfortunately, I didn't pay enough attention because of it. For instance, I didn't know that they would be giving me a nerve block for the surgery and this was inserted into my neck (like an epidural would be in your back). I also didn't know I wouldn't be able to move my arm. I mean literally at all. In fact, it was dead weight for 3 days. But, I should be glad because I felt no pain! (other than in my shoulder from carrying the weight of that arm with my other arm). It was very weird to wake up and not feel my arm. I also had a very weird complication that had me go back to the ER.... after they released me from the hospital, over the course of that first night, I actually stopped being able to pee! I had to go the next day to get my bladder drained! It was SOOOO painful and scary. They told me later ( after a urology visit) that after 3 kids, my bladder had dropped and it sometimes can pinch off the urethra (if your bladder gets too full) and, after surgery, sometimes it can take up to 48 hours for the proper functioning of our bladders to "wake up". Who knew? Well, I wouldn't wish that on anyone. They sent me home with a foley catheter. So there I was walking around, carrying a pain pump wearing a catherer strapped to my leg and holding my right arm up and elevated. I was miserable!!!! Sometimes I feel like I'm such a doufus.

But that is all over now and I am really hoping I can get the LVA done.

The only other thing is that my right arm looks much smaller than my left one (I knew it would but seeing it is kind of another thing). I am hoping to lose some weight and then my left arm will lean out a little. And, I need to do some light weights and regain some muscle definition in my right arm (after being immobile and wrapped for so long, it got kind of wimpy looking). It will even out over time. But, it definitely looks different. Eventually, I can get a little lipo on the other arm if needed. But this is what the surgery was intended for! Hope you all understand what I'm trying to describe (want it/don't want it). But, looking just at my right arm, it looks fantastic and the scar is very tidy. It's just now my left arm is jealous of my right arm!

But I have NO pain in my right arm, NO aching, and NO swelling (although I had to work to that for several weeks post op). I am not testing if I can go wiithout compression garmets, nor will I for at least a year. I am hoping for some compression free hours eventually but I'm told there isn't a guarantee.

Sorry to leave such a long post but I hope it's useful.

Amanda

Amanda Dx 10/20/2008, ILC, 3cm, Stage IIIA, Grade 2, 4/17 nodes, ER+/PR+, HER2-
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May 27, 2021 10:44PM Linda2119 wrote:

Thanks so much for reaching out, Amanda.

Surgery for me is June 9. I am encouraged by your experience. I have been feeling some trepidation about the surgery, especially since so much time has passed since my appointment with Dr. Chen. I've tried to get some post-op info from the PA, but she has been quite vague - keep arm elevated, 10 minutes of activity at a time. In my head and at night, I'm worried about all sorts of things - and I'm not typically a worrier, just a planner. But things like - how to get through an airport with your arm elevated, should I get an arm elevation pillow of some type to sleep with, etc. I'm glad you mentioned the dead weight arm. I'm also so sorry you had the bladder issues.

I'll be sure to write after my surgery.

Linda

Dx 10/5/2017, DCIS/IDC, Left, 2cm, Stage IIIC, Grade 2, 15/24 nodes, ER+/PR-, HER2- (FISH) Hormonal Therapy 10/18/2017 Arimidex (anastrozole), Faslodex (fulvestrant) Surgery 3/19/2018 Lumpectomy: Left; Lymph node removal: Sentinel, Underarm/Axillary; Reconstruction (left) Chemotherapy 4/18/2018 AC + T (Taxol) Surgery 9/8/2018 Mastectomy: Left; Reconstruction (left): Silicone implant Radiation Therapy 10/24/2018 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy 12/5/2018 Arimidex (anastrozole) Targeted Therapy 12/19/2018 Verzenio
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May 31, 2021 03:41PM MandaLynn wrote:

Hi Linda,

I was wondering about exactly the same things as you (airport etc). They give you an arm sling which helps a lot. I bought two different arm bolsters off Amazon that I used at different times.

But frankly, they made me realize that I was overthinking everything. They are much more “casual” about everything. I held my arm up as much as I could through the airport but sometimes it was down (in the sling).

it all goes by so quickly!

The main thing is wrapping the arm. I was very diligent.


Good luck to you.


Amanda Dx 10/20/2008, ILC, 3cm, Stage IIIA, Grade 2, 4/17 nodes, ER+/PR+, HER2-
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Jun 25, 2021 05:11PM Linda2119 wrote:

Hi, Amanda and toomuch,

I'm 16 days out of surgery. Surgery for me went without a hitch. No nerve block for me, and pain was very manageable. They did keep me overnight - not sure why (and my insurance company is treating it as a hospital admission which they say was not medically necessary and won't cover, but that's another story.)

The bandaging is restrictive but tolerable. But the constant elevation and no more than 10 minutes standing/walking is harder to handle. I'm not much of a TV watcher so I get really bored. I'm down to 11 more days!! My hand and fingers are still quite swollen.

Like Amanda, my arm is thin. I wish he had left a little more fat in my upper arm. At my first appointment with Dr. Chen, he mentioned cosmetic surgery on the other arm, but when I asked him about that this time, he made it sound like patients rarely ask for the additional surgery.

Another frustrating inconsistency from Dr. Chen was discussion of future surgery. First it was the lymph vessel transfer. Then during my preop, he said LVA. Said he only did 7 LVT's last year. But then during the postop appointment, he was back to LVT. I know I just need to wait and see what the 3 month ICG shows.

I'm very eager to get my compression sleeve ordered - I want to stop bandaging asap and get back to my fun activities. But I need to wait for my arm swelling to stabilize. I'm not totally clear on what to look for to determine whether it has stabilized. I would have appreciated more clarity on that.

Amanda - looking forward to hearing how your 3 month appointment / ICG scan goes. And any other words of wisdom you can offer!

Toomuch - let us know what you decide to do!

Linda


Dx 10/5/2017, DCIS/IDC, Left, 2cm, Stage IIIC, Grade 2, 15/24 nodes, ER+/PR-, HER2- (FISH) Hormonal Therapy 10/18/2017 Arimidex (anastrozole), Faslodex (fulvestrant) Surgery 3/19/2018 Lumpectomy: Left; Lymph node removal: Sentinel, Underarm/Axillary; Reconstruction (left) Chemotherapy 4/18/2018 AC + T (Taxol) Surgery 9/8/2018 Mastectomy: Left; Reconstruction (left): Silicone implant Radiation Therapy 10/24/2018 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy 12/5/2018 Arimidex (anastrozole) Targeted Therapy 12/19/2018 Verzenio
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Jul 31, 2021 09:36AM toomuch wrote:

Amanda and Linda,

I'm sorry that I have been offline for so long. Thank you so much for posting all this amazing information!

Amanda, I'm sorry you had a rough post-op course.

I have had to keep my arm wrapped almost 24-7 from February 2020-June 2021! When I tried to wear a compression garment my hand swelled. Needless to say I've gotten very good at wrapping!

I ended up getting a 2nd opinion and had LVA surgery in March knowing that I would likely need liposuction to treat the solid component. I normally work in an Emergency Department but for more than a year, I did telemedicine. The hope was that the LVA would allow me to work unwrapped without getting significant swelling or cellulitis. I haven't had cellulitis since the procedure but my arm does swell after every shift. It usually takes about 2 days of MLD, using the pump and wrapping to get it back down. But the LVA definitely helped with my hand and wrist swelling. At least now I feel like I can go a few hours unwrapped without serious swelling and I can get the swelling down much faster than before the LVA.

I'm scheduled to have liposuction in December. I have loose skin on my good arm without a lot of fat and I don't want to have one really skinny tight arm and one wiggly one. Just a personal choice. I'm also going to have an ICG prior to surgery to see if there are any additional places for LVA. I am planning to take 3 months off after surgery to wrap and wear compression but I hope after that I will be able to return to work without developing significant swelling. I do anticipate that I will have to wrap for a day or two after each shift.

How many days after your surgery were you able to fly home? I haven't gotten post-op instructions but only walking for 10 minutes at a time and otherwise keeping your arm elevated for a full month seems tough. I did that completely for 2 weeks after the LVA surgery and for the next 2 weeks I didn't really exert myself and of course didn't lift anything heavy but I did take slow walks and cook.

'Linda, are you seeing a lymphedema therapist? She/he could probably tell if your arm has stabilized.

I'm glad to hear that you're both doing well! Please update this site with your progress!

Toomuch


"Every trial endured and weathered in the right spirit makes a soul nobler and stronger than it was before" Dx 7/13/2010, ILC, <1cm, Stage IIA, Grade 2, 2/12 nodes, ER+/PR+, HER2-
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Aug 14, 2021 04:34PM Dtodd wrote:

I had the flying squirrel one year ago. It has been an absolute life changer for me. I was having constant infections, was on antibiotics twice per day and my arm was so huge my clothes didn’t fit. Physically and mentally it was wrecking my life. I had the surgery with Dr Chen. He was wonderful!! The recovery was easy. I lost 6lbs from my arm. I have had NO other infections. I’m off antibiotics and I feel wonderful. I’ve lost 40 lbs and have a new life. I would recommend Dr Chen and this procedure to anyone. I’ve been back to Cleveland for 3 follow up 3 times. My vessels have shown improvement on each visit. I go next week and will decide whether to have the LVA if possible or the vessel transfer. I really need neither but would like to ditch the compression sleeve. If anyone had had the transfer I would love to hear if your experience. Good luck and God bless!

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Aug 14, 2021 04:38PM Dtodd wrote:

it’s a wonderful solution!! Just have it. See my

Post at the end of the threa

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Aug 17, 2021 11:48PM Linda2119 wrote:

Dtodd- please let me know how your appointment goes with Dr. Chen. I'd love to hear what he recommends for the next surgery.

I have no regrets about my surgery. I am now in custom compression sleeve/glove and a nighttime sleeve. I also use my pump regularly. The difference is that the pump works! Before, it never did much. Now, I see a difference each time.

I'm seeing my PT two times per week so we can get the swelling as much resolved as possible before my follow up with Dr. Chen on 9/17.

Toomuch - I had surgery on Wednesday, my follow up with Dr. Chen on Monday and I flew home that day. It was a long day but so good to be home.

Dx 10/5/2017, DCIS/IDC, Left, 2cm, Stage IIIC, Grade 2, 15/24 nodes, ER+/PR-, HER2- (FISH) Hormonal Therapy 10/18/2017 Arimidex (anastrozole), Faslodex (fulvestrant) Surgery 3/19/2018 Lumpectomy: Left; Lymph node removal: Sentinel, Underarm/Axillary; Reconstruction (left) Chemotherapy 4/18/2018 AC + T (Taxol) Surgery 9/8/2018 Mastectomy: Left; Reconstruction (left): Silicone implant Radiation Therapy 10/24/2018 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy 12/5/2018 Arimidex (anastrozole) Targeted Therapy 12/19/2018 Verzenio
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Aug 18, 2021 08:49PM footloose wrote:

Can anyone explain "flying squirrel" surgery to me?

Thanks, Footloose

Dx 1989, IDC: Papillary, Left, <1cm, ER+/PR- Dx 6/2002, DCIS, Right, <1cm, Stage 0, ER+/PR-, HER2- Dx 11/2005, DCIS, Right, Stage 0, Grade 3, ER+/PR- Dx 12/18/2018, IDC, Right, 1cm, Stage IIA, Grade 3, 1/13 nodes, ER+/PR+, HER2- (DUAL) Dx 1/28/2019, IDC, Right, <1cm, Stage IIA, Grade 3, 1/13 nodes, ER+/PR-, HER2+ (DUAL) Dx 1/28/2019, IDC, Right, 1cm, Stage IIA, Grade 3, 1/12 nodes, ER+/PR-, HER2-

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