MLD and Recovery

Manual Lyphantic Drainage (MLD): How It Works

The macom® team has, for years, worked closely with certified manual lymphatic drainage (MLD) therapists ensuring that all our compression garments and bras are observing best protocols for speeding up the recovery time for patients. MLD is a specific massage technique which can be fundamental in helping a patient in the healing journey alongside wearing macom medical wear.

We will be dedicating some important information and facts about MLD and how it is a recognised fact that this can help enhance surgical outcomes.

World renowned MLD & Clinical Massage Specialist, Clare Anvar who also holds a title as MLDuk trustee will share her knowledge around this subject and demystify how this specialist massage technique work and why you need it.

MLD stands for Manual Lymphatic Drainage and it is a group of specialised massage techniques. MLD is used in post-surgical recovery to promote wound healing, support the immune system and improve the reabsorption of swelling and waste products (bruising, proteins, cellular debris) from the spaces between the cells in the tissues.

Compression garments are an important tool to help fluid transport and drain out of the area.

Most therapists are trained in a whole range of therapies which sppeds up recovery and don’t only practise one thing, like having a toolbox, so they can tailor treatments to individual needs. MLD is the best skill and the other therapies enhance its effectiveness.

Different techniques:

-Lymphatic Kinesiology Taping is the same tape that athletes use but is applied in a different way to enhance lymphatic drainage. It can be applied after MLD to reduce swelling and bruising. It also helps with complications such as seromas and haematomas.

-Deep Oscillation is an electro-static therapy, which is applied via gloved hands to enhance MLD. Whilst performing MLD electro-static waves gently vibrate the tissues, at different frequencies, to release static fluid and move it into lymphatic vessels. Excellent for speeding wound healing, reducing swelling and bruising.

While cosmetic surgery is a controlled trauma, nonetheless, it is a trauma. The surgical area has been injured and needs to recover. It is the job of the lymphatic system to fight infection, reduce inflammation and clear the damaged area of swelling, bruising and residual toxins and promote wound healing. With so many jobs to do, the lymphatic system can be easily overwhelmed, as it is also damaged from the surgery. MLD and associated therapies enhance and support the natural function of the lymphatic system. This means it can work much more efficiently and does not get overwhelmed, lessening the chance of stubborn bruising, hardening of the tissues and uneven, lumpy results-especially following fat transfers and liposuction.

In certain cases, seromas (a collection of serous fluid) or haematomas (deep bruising) occur. MLD (supported with Deep Oscillation and Lymphatic kinesiology taping) can quickly and effectively manage these complications.

-Myofascial Release works on the connective tissues and is used to promote smooth scar tissue formation and deal with keloid and hypertrophic scarring. It also reduces tightness and stiffness.

Every case is different depending on the type and extent of the surgery. Having the MLD treatment for 6 weeks is ideal for cosmetic procedures: twice a week for the first couple of weeks, to be reviewed after that. 

There are many advantages for using specialist post-surgical therapies including MLD.

• The lymphatic system is supported to make patients heal substantially faster
• Anaesthetics are evacuated from the system more quickly
• The inflammatory phase of recovery is sped up
• Wound healing is accelerated
• Scar tissue is laid down evenly
• Complications can be rectified
• Smooth, even results are achieved
• Results are attained more quickly
• Patients can return to their daily lives much sooner
• Trained therapists provide a professional link between patient and surgeon, to report any issues, such as anaemia or infection or any unexpected problems.       In my case, the patient has my phone number to call 24/7.
• Therapists also give much needed psychological support through recovery. Many patients completely underestimate the impact of their surgeries or how they will be affected emotionally.

Disadvantages:

The only real ‘disadvantage’ is the financial cost of trained therapists. Personally, I think that professional aftercare is a worthwhile investment. Patients spend months researching their surgeon only to leave their aftercare to chance, or advice from Facebook forums or Youtube videos, which often can give misleading information.

Increasingly, surgeons are offering aftercare packages within the final cost of the surgery, if they have in-house MLD therapists connected to their practices. This means patients can budget and do not need to find additional funds after their surgery.

Treatments can start less than 24 hours after surgery. Many surgeons like to leave 24 hours to make sure that all bleeding has stopped and the surgery site is stable.          

MLD and deep oscillation can be delivered, without pain or discomfort, to relieve the immediate pressure of post-operative swelling. I am always guided by the individual surgeons. Often with liposuction procedures, especially those undertaken in Germany, MLD is given before discharge from the hospital, less than 24 hours post-liposuction and continued under a strict schedule up until six weeks post-procedure.

Every person is an individual, with totally individual needs. There are many contra-indications, only a couple of absolute contra-indications, but I can’t stress enough how important it is to choose a therapist who has a sufficient level of training to look after you safely. There are many lymphatic drainage courses available in the UK that train beauty therapists in aesthetics. Some of these therapists advertise that they treat cosmetic post-surgical patients. They are much cheaper to employ. However, the skill of a therapist is not to look after straightforward cases, their skill is to recognise when things are not right and when complications can be life threatening.                                 

Many cosmetic surgery patients think that because they are physically fit and have elected to have surgery, that they are not at risk of complications. Every surgery carries risks and it is a false economy for patients to see therapists who do not have the correct skill set to look after them safely.   

MLD is appropriate for all surgeries and almost every patient. Again, it is the level of training of the therapist, which will determine who they are insured to treat. MLD is used for cancer patients at every stage of their journeys, in hospitals and hospices, for babies and for the very frail, poorly and elderly.

The easiest way to find an insured MLD therapist is to go to the MLDuk website www.MLDuk.org.uk.

As a therapist, to be registered with MLDuk, you must be trained by one, or more, of their approved schools (Vodder, Földi, Casley Smith or Fluoroscopy Guided MLD). All therapists must review their skills and training every other year to maintain registration.

MLDuk hold a register of therapists from all over the UK. Put in your postcode to find therapists local to you. There are only about 500 in the whole of the UK. We are a very small community!  Any therapist on the MLDuk register is qualified to give post-cosmetic surgery care.

A therapist with DLT after their name means that they have had specific training to work with cancer patients and understand compression therapy. These therapists can be registered with BUPA and other health insurance companies.

There are many excellent therapists who are not registered with MLDuk at all, or their membership has lapsed. Research them and call them to ask about their experience. Any professional therapist will be happy to have a chat.

There is a MLD treatment for each part of the body, but again, every person is different so there is no exact routine, as with a spa massage.

The body drains lymphatic fluid in specific routes and directions. MLD follows these drainage pathways. MLD moves fluid from areas which are not draining, to areas which are draining freely.

macom® garments are beautifully designed with lymphatic drainage in mind, very good quality and provide excellent, comfortable compression.

For abdominal surgery is best to wear garments with closed crotches. The important thing with any garment is that it fits correctly. Poorly fitting garments can cause all sorts of difficulties.

• Compression is not to be confused with CONSTRICTION!
• Garments should be smooth, comfortable and hold you gently

• Over-compression can cut off the blood supply
• Poorly fitting garments can stop lymphatic drainage
• A garment that is too long in the body and creases, causes double compression at the creases and causes ridges in the skin, leading to uneven results. Inserts can be very effective to apply between the skin and the garment to ensure skin does not get any creasing. macom® inserts are form-stable meaning they will not create any kinks or ridges into the skin and thus aiding the lymphatic flow.

It is recommended to wear the macom® garments for about 6 weeks, 24 hours a day to begin with, reducing as time goes by. macom® provides stage 1 and stage 2 garments. Stage 1 are for immediately post-op and 2 for further along in the healing to provide longer term support. Often garments are purchased before the surgery, so sizing can be an issue. Each surgeon has different protocols about when to wear compression and for the length of time to wear it. I always defer to their expertise. If I feel there would be a better solution with an individual patient, I email the surgeon and recommend a different garment.

Improving lymphatic drainage through macom garments:

Implant removal (without replacement):

When having breast implants removed compression is imperative to help with tissue retraction and helping the breast restore back to its former shape. A retractable bra is needed which will help the healing process, reducing risks and optimising the lymphatic drainage process. The Explant (still in development) and Minimizer bra both have wide, adjustable straps to unsure lymphatic flow is drained well towards the collarbone. The vest has a longer body to further extend the fluid drainage cycle.

Breast surgery:

All macom bras have been designed to enhance the lymphatic drainage recovery through its seamless cups which are also fully expandable. The bra follow the wearer’s chest and torso contour and therefore minimising empty spaces where fluid could potentially get trapped. All the first stage bras have full chest coverage to ensure that the area is fully supported and fitting close to the armpit. The Ultimate bra is the latest macom® bra launched which has a longer body for added key compression.

Abdominal surgery:

macom® girdles are low vintage fitting to ensure there is no disruption to the lymphatic flow in the groin area. Seams are flat and outward facing to stimulate optimal scar healing and good supply of blood and oxygen. Due to the silky material the garments are made from, even the most delicate skin can use macom® girdles. Side fastening girdle has a detachable gusset with has been tested on women of all shapes and sizes (from XXS to XXXXXL) and the hook & eye fastening has been strategically placed on the side to ensure minimal disruption to the trauma site.

Leg surgery and lymphedema:

The most potent garment for the legs are macom® Leggings. These leggings have a closed gusset and delivers key compression to the lymph nodes in the groin and the back of the knee. Silky and soft to the touch and fully opaque in its design allows these leggings to be worn like a pair of leggings. Only the toes are exposed outside the garment, which means that the legs are being fully supported in lymphatic drainage. The waist band has adjustability through a comfortable drawstring while giving the abdomen a gentle compression.

Arm surgery and arm lymphedema:

The axillary lymph nodes link into the arm and therefore it can be a good option to have a garment which covers the arm, armpit and the chest, like the macom® Sleeved bralet. Even if the patient has not had surgery to the chest, the expandable cups will mould to the wearers chest size making this a very comfortable all-in-one recovery option.

Male procedures:

All male compression vest are fitting high up in the armpit to ensure optimal compression on the axillary nodes to stimulate lymphatic drainage. The macom® Body brief has the briefs attached to the body to avoid any disruption of draining of fluid and full coverage on the groin are where the inguinal nodes are found.

 

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My name is Clare Anvar. I have been a clinical massage therapist since 2004, specialising in all types of post-surgical recovery and disorders of the lymphatic system. Because the lymphatic system has so many roles in the body, I have a very varied practice. I work with patients with autoimmune disorders like rheumatoid arthritis & inflammatory bowel diseases, post viral syndromes, Lyme disease, HIV, post-traumatic stress disorder, lymphoedema and lipoedema.

I have extensive experience with many types of short & long-term surgical recovery; oncology, orthopaedics, reconstructive and cosmetic. Alongside my private practice, I have always studied and worked in different clinical environments. From 2004-8, I was a therapist with an HIV charity and a local cancer charity. From 2008-2011, I was a complementary therapist in Cancer Services at University College London hospital (UCLH), while studying a BSc (Hons) Health Sciences; remedial massage & neuromuscular therapy. I then worked with a private orthopaedic hospital in Sussex, Horder Healthcare, while studying an MSc in Complementary Medicine, which was completed in 2015. I have just began working from the renowned plastic surgery hospital the McIndoe Centre at East Grinstead. I am trained in many therapies, myofascial release, scar work and three schools of MLD. I teach lymphatic kinesiology taping and speak at conferences about my work.

I have two websites www.clareanvar.com and www.evolvemassage.co.uk. I am based in Kent. My phone number is 07731547754 if you would like any help or advice.