MQ Health - Macquarie University

Lymphoedema Clinic

Conditions and Treatment

Lymphoedema is swelling caused by damaged or abnormal lymphatic vessels and requires ongoing monitoring and management.

The aims of lymphoedema treatment are to prevent progression of the condition, to reduce oedema and then maintain the improvement. This includes the alleviation of associated symptoms, prevention of infection and improvement of function and quality of life.

The ALERT program offers management of all types and stages of lymphoedema, supported by research and education initiatives, to provide the best service to our patients.

Please see an overview of our different services below.

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Diagnostic clinic

At our diagnostic clinic, an expert team of doctors and lymphoedema therapists will assess you using state-of-the art diagnostic equipment, including MRI and lymphoscintigraphy. We can help provide you with a diagnosis or personalised treatment plan to help improve your lymphoedema.

This clinic also uses indocyanine green (ICG) fluorescence lymphography to allow us to visualise your lymphatic system in real time and improve lymphatic drainage massage techniques. The ICG examination takes approximately 1 ½ hours and includes the following steps:

  • you will be given 4 small injections of ICG to the affected area
  • this is followed by an initial observation period (20 minutes)
  • the lymphoedema therapist will then perform manual lymphatic drainage to determine your individual drainage patterns (30 – 60 minutes)
  • the lymphatic pathways will be drawn onto your skin with a marker pen and photographed for your report

Within 1-2 weeks of the test, you will receive a detailed report to take back to your doctor and/or lymphoedema therapist.

Only a tiny amount of ICG dye is injected during the imaging process and the risk of severe allergic reaction is rare. However, the test is not advised for people who are allergic to shellfish or iodine. Please let the clinic know if you have a shellfish or iodine allergy.

ICG imaging is not covered by Medicare and a fee will apply. Contact the clinic for details.

Conservative treatment clinic

This clinic offers non-surgical treatment for those at risk of or living with:

  • Primary lymphoedema
  • Secondary lymphoedema
  • Head and neck lymphoedema
  • Breast, trunk and abdominal lymphoedema
  • Lipedema

What we offer

  • Assessment and diagnosis of lymphoedema using state-of-the-art imaging equipment
  • Pre-operative bioimpedance spectroscopy (BIS) screening (lymphoedema index) and education
  • Post-operative care after breast cancer treatment, including management of scarring and cording
  • Ongoing monitoring and education for people at risk of developing lymphoedema
  • Complex lymphoedema therapy (CLT) including:
    • Skin care and exercise advice
    • Advice and education about lymphoedema
    • Manual lymphatic drainage
    • Compression bandaging, garment prescription and fitting
    • Low level laser therapy
    • Intermittent pneumatic compression
    • Kinesiology taping
  • Referral to our Surgical Assessment Clinic if applicable

Our clinic offers a unique diagnostic, treatment and follow-up service for patients at risk of or living with lymphoedema. We will develop a treatment plan that best suits your individual needs.

Not all components of treatment will be necessary in all cases. Those with mild lymphoedema may only require education, exercise and skin care, whereas for more severe cases treatment may be longer and require two phases. Phase I is an intensive treatment provided by a trained lymphoedema therapist followed by Phase II, which is self management that the patient continues at home. With improved health education people are reporting early limb changes promptly and this is contributing to a reduction in the need for intensive treatments.

Surgical assessment clinic

An important part of the ALERT clinical care and research program is the surgical assessment clinic. The clinic is an important first step in determining the presence and extent of lymphoedema and your suitability for surgical intervention using specific criteria. We also diagnose and manager lipedema.

A medical referral is required for assessment by the multidisciplinary team.

The ALERT treatment difference

In your initial visit to the surgical assessment clinic you will be assessed by Dr Helen Mackie (lymphoedema medical specialist) and a lymphoedema therapist. A medical and lymphoedema history will be taken as well as a complete physical, functional and psychological assessment about the impact that lymphoedema has on your life. You will be encouraged to fill in some questionnaires and have measurements taken.

Physical measurements may include: circumferential measurements using a tape measure; bioimpedance spectroscopy (BIS) measurements to monitor the fluid; range of movement measurements of your limb and joints; how hard or soft the limb feels and whether the symptoms vary with time.

Functional assessment may include: how the lymphoedema symptoms affect your ability to complete everyday activities such as personal care, household tasks, paid and unpaid work, sleep and leisure activities.

Research shows us that living with lymphoedema can impact your feelings and emotions. The clinical team wants to assist in managing lymphoedema across all aspects of life and wants to provide support and strategies in dealing with psychological symptoms.

Patients attending the clinic may also be encouraged to complete further diagnostic testing such as lymphoscintigraphy, MRI scanning, ultrasound and blood tests. The results of these will be used to help the team understand your condition and gain better knowledge of how lymphoedema develops and what might be the best treatment recommendation for you.

Following initial assessment in the lymphoedema clinic, recommendations for further assessment and management will be made in consultation with yourself and the team according to your own personal goals and needs. A follow-up appointment will be scheduled if required.

If you are considered appropriate for surgical options you will be given written information and an appointment to see one of the plastic surgeons on the team. We offer three different surgical options, lymphovenous anastomosis (LVA) and lymph node transfer (LNT) for early to moderate lymphoedema and liposuction for advanced lymphoedema and lipedema.