The use of high tumescent power assisted liposuction in the treatment of Madelung’s collar

Mild symmetrical lipomatosis (plural symmetrical lipomatosis, multiple symmetric lipomatosis – MSL), also known as Madelung’s disease or Launois-Bensaude syndrome is a rare disease of unknown etiology, first described by Brodie in 1846, Madelung in 1888, and Launois with Bensaude in 1898 [1–3].
Madelung’s disease incidence is 1 : 250000 [4]. Multiple symmetric lipomatosis occurs mainly in the inhabitants of the Mediterranean area and Eastern Europe, in males (male to female ratio is 20 : 1), aged 30–70 years, usually in conjunction with a heavy abuse of alcohol (up to 90% of cases) [4].
It is often associated with other disease entities – liver disease, impaired glucose tolerance, hyperuricemia, hypothyroidism, hypertension, and hyperlipidemia [5]. Most of the reported cases of this disease occur sporadically, although family forms with autosomal dominant or maternal mitochondrial inheritance formula are known [6–9].
The characteristic image of this disease is symmetrical subcutaneous adipose encapsulated tissue accumulation, which is slowly and continuously increasing in the neck, the upper part of the upper limb, pelvic rim, back and thighs. Two main types of the disease are described and classified on the basis of fat distribution: type I where lipomas gather around the neck, supraclavicular area and around the shoulder – giving the image of Madelung’s collar or a pseudo-athletic figure, in type II fatty tissue develops under the skin evenly giving a picture of simple obesity with excessive fat deposits in the vicinity of the back, shoulders, hips, and upper thighs. Another classification distinguishes three types of body profiles in patients with Madelung’s disease; type of cervical location, pseudo-athletic and gynecoid (abdomino-iliac) type [10].
The disease most commonly takes a proximal form which takes the following areas of the body with the following frequency: the genial area 92.3%, cervical region 67.7%, shoulder region 54.8%, abdominal 45.2%, chest 41.9%, thigh and pelvic rim 32.3% [11, 12]. The peripheral type mainly locates on both sides at the level of the hands, feet and knees, this is definitely a rarer form of the disease. The mixed form is described very rarely. The specified central type is also engaged primarily around the lower torso, and intermediate parts of the legs. Typically for the Madelung’s disease, the gluteal region and shanks are not occupied [13].
Moreover, an unsightly appearance of the...


View full text...