Baseline subcutaneous adipose tissue volume as a potential determinant of lymphedema manifestation

Lymphedema is a pathological condition characterized by swelling of the affected body region and debilitating discomfort due to functional impairment of the lymphatic system. Despite its clinical significance, the pathophysiology underlying its onset and the factors regulating its severity remain poorly understood. Its markedly higher prevalence in women has yet to be explained. Lymphedema is traditionally described as a consequence of imbalance between interstitial fluid production and lymphatic drainage capacity. However, no established method currently exists to quantify either of these volumes. In this article, we aimed to address several unresolved aspects of lymphedema pathophysiology, including the inability to develop a reliable animal model, the vulnerability of women, the different presentations of the affected limb between lean and overweight patients, and the onset of primary lymphedema during puberty. We used imaging data as supportive evidence and proposed an anatomy-based hypothesis in which the baseline volume of subcutaneous adipose tissue may determine lymphedema development and its manifestation as a clinically measurable parameter.