Manhattan Beach Lymphedema Surgery

Lymphedema Surgical Treatment Options

Dr. Granzow is an internationally known pioneer in the field of lymphedema surgery in the Manhattan Beach area. He has extensive expertise performing lymphedema surgical procedures including:lymphedema_illustration

  • Vascularized Lymph Node Transfer (VLNT)
  • Lymphaticovenous Anastomoses (LVA)
  • Suction Assisted Protein Lipectomy (SAPL)

Dr. Granzow integrated these procedures into a comprehensive system with lymphedema therapy, known as the Functional Lymphatic Operations (FLO)SM System. This system is the first in the world to integrate and combine surgical and non-surgical lymphedema treatments to address the various stages of lymphedema. Dr. Granzow has published his results in leading medical journals.

While VLNT, LVA and SAPL each are most effective in treating a specific subset of patients, no single procedure is best for all patients. Dr. Granzow carefully selects and matches each patient with the optimum therapy and surgical regimen to treat their lymphedema.


For additional information about Lymphedema Surgery and Specialized Microsurgery, please visit our sister website at:

Patient Selection

Both vascularized lymph nodes transfers (VLNT) and lymphaticovenous anastomoses (LVA) are most effective in patients whose lymphedema swelling is mostly due to excess fluid.  Patients with more advanced, chronic lymphedema may have swelling mostly due to deposits of excess fibrotic tissue, protein and fat.  This excess solid instead may require removal using suction assisted protein lipectomy (SAPL).

Prior to any lymphedema surgery, patients should be treated by a lymphedema specialized therapist.  As part of the therapy, patients should undergo at least one course of complete decongestive therapy (CDT) reduce the excess volume in their arm or leg as much as possible.  CDT involves specialized manual lymphatic drainage or massage, compression bandaging and garments, skin care and exercises as appropriate for each patient.  This may avoid the need for surgery for lymphedema, and greatly assists in the proper evaluation for surgery if it should be required.  Many of our patients have achieved tremendous improvements in their lymphedema symptoms.  However, patient compliance with lymphedema therapy is an integral component for a successful surgical outcome.

Vascularized Lymph Node Transfer (VLNT)

VLNTs can be an effective method for the treatment of lymphedema of the upper and lower extremity. Lymph nodes are harvested from the donor area with their supporting artery and vein and moved to the area of lymphatic blockage. Dr. Granzow then uses specialized microsurgical techniques to reconnect the artery and vein to new blood vessels at the recipient site to provide the vital circulation to the lymph nodes while they develop their own blood supply over the first few weeks after surgery.

The newly transferred lymph nodes then serve as a conduit or filter to remove the excess lymphatic fluid from the arm or leg and return it to the body’s natural circulation.

Dr. Granzow uses specialized radiographic imaging to perform sentinel lymph node mapping to identify and avoid harm to critical lymph nodes at the donor site.  This is performed to minimize the chances for having lymphedema occur at the lymph node donor site.

This technique of lymph node transfer usually can also be performed together with a DIEP flap breast reconstruction. This allows for both the simultaneous treatment of the arm lymphedema and the creation of a breast in one surgery. The DIEP flap provides the opportunity for a beautiful and natural appearing breast reconstruction combined with the abdominal contouring very similar to a tummy tuck. The lymph node transfer removes the excess lymphatic fluid to return form and function to the arm and torso.

Lymphaticovenous Anastomosis (LVA)

Dr.Jay Granzow (right) and Dr. Isao Koshima (left) performing lymphaticovenous anastomoses in Japan in 2005

Lymphaticovenous anastomosis describes the use of supermicrosurgery to connect the affected lymphatic channels directly to tiny veins located nearby. The lymphatics are tiny, typically approximately 0.1 mm to 0.6 mm in diameter. The procedure requires the use of specialized techniques with superfine surgical suture and an adapted high power microscope.

The procedure can be an effective and long-term solution for extremity lymphedema, and most patients in our experience have results that range from a moderate improvement to an almost complete resolution of the problem.

Dr. Granzow adapted his surgical technique from the father of supermicrosurgery, Dr. Isao Koshima. He studied with Dr. Koshima in Japan and still maintains close professional contact with him. Dr. Koshima has pioneered the field of supermicrosurgery and applied his methods to the lymphaticovenous anastomosis procedure. Current results show much greater success rates than were reported previously by other surgeons who attempted to perform the lymphaticovenous anastomosis technique.

Suction Assisted Protein Lipectomy (SAPL)

Some Manhattan Beach patients have more advanced, chronic lymphedema in which the swelling is mostly due to deposits of excess fibrotic tissue, protein and fat.  The arm or leg may be either is either soft or firm, and is no longer characterized by “pitting” edema/fluid. This excess solid instead may require removal using suction assisted protein lipectomy (SAPL).

SAPL is quite different than cosmetic liposuction, and has been pioneered by Dr. Hakan Brorson who first performed the procedure over 20 years ago in Malmo, Sweden.

SAPL effectively reduces the size and stiffness of the affected arm or leg with chronic, solid predominant lymphedema. However, a significant limitation of the technique has been that currently the procedure must be followed by lifelong use of compression garments to prevent a recurrence of the lymphedema fluid reaccumulation.

Dr. Granzow has pioneered a combination of SAPL and VLNT to address both the solid and fluid components of chronic lymphedema swelling.  In such cases, SAPL is performed first to remove the excess solids. VLNT is performed after healing following SAPL has taken place to address the fluid component and reduce the need for compression garment use after the surgery.

Excess fluid may be present to different degrees as well in cases of chronic lymphedema, and may require lymphedema therapy prior to surgery to achieve the best long-term result.

For additional information about Lymphedema Surgery and Specialized Microsurgery, please visit our sister website at: