Lipedema – When do health insurance companies pay for liposuction?


Lipedema is a metabolic disease in which affected individuals experience uncontrolled growth of fatty tissue on the legs, and less commonly on the arms. The disease occurs almost exclusively in women and leads in the long term to pain, restricted freedom of movement, a malposition of the joints, strong pressure sensitivity of the skin and premature joint wear.

Four stages of lipedema are distinguished

The differentiation of the stages is based on the condition of the tissue structure of the affected areas:

  • In the first stage the skin surface is smooth, but the subcutis is thickened and the fat structure in the tissue is finely nodular.
  • In the second stage of the disease, the skin surface is already uneven and the fat structure is coarse.
  • In the third stage the tissue of the affected person is additionally hardened and large-lobed fat lobes form, deforming the appearance of the affected limbs.
  • In the fourth stage severe lipolymphedema also occurs.

A common criticism of this classification is that it only considers the external appearance of the disease. This is because even with stage I lipedema, affected women can suffer from severe pain that makes walking and standing almost impossible.

Meanwhile, the long-invisible disease has found its way into federal politics. In January 2019, German Health Minister Jens Spahn announced that health insurance companies will have to cover the costs of liposuction for severe lipedema in the future. Since the beginning of 2020, liposuction for stage three and four lipedema has been a health insurance benefit.

For now, coverage by health insurers for stage III lipedema is only set until December 31, 2024. During this period, a trial study is being conducted to evaluate liposuction in all stages of the disease. Nevertheless, the criteria necessary for liposuction are strictly interpreted. For example, those affected must have undergone conservative therapies for at least six months, even if they have been shown to have no effect. Only when both sport, exercise and lymphatic drainage have failed to bring about any improvement do health insurance companies pay for the procedure. In addition, there are always cases in which health insurance companies subsequently refuse to cover the costs. For many of those affected, this situation is untenable.

How do sufferers experience dealing with the disease?

Affected women who underwent surgery due to the physical and psychological suffering caused by lipedema report that they were already barely able to walk at a young age due to the condition, and sports only made the symptoms worse. However, if the lipedema has only reached stage two, health insurance companies refuse to cover the intervention.

Lipedema cannot be cured. Therefore, treatment of the condition is designed to reduce discomfort and prevent further increases in fat deposits. Since lipedema worsens over time in many sufferers or the symptoms are no longer treatable, liposuction is inevitable for many. However, the procedure is very expensive. – An operation on the thigh costs up to €2,900, but for many patients this has to be performed several times, as a maximum of five to seven liters of fat can be removed in a single liposuction. In this way, treatment costs of more than €10,000 can easily accumulate for those affected. Another hurdle is that the G-BA, i.e. the joint federal committee of doctors, clinics and health insurance companies, has spoken out against the assumption of the operation from the beginning, since the success of the treatment has not been confirmed and risks such as inflammation can occur.

Also the Practice Plastic Surgery Dr. Bernard in Munich Offers liposuction procedures. During the procedure, a solution of anesthetics and medication is first injected into the skin to facilitate suction. Then, the fat tissue is suctioned out through small incisions in the skin using cannulas. After the procedure, patients must wear special compression garments for six weeks to allow the tissue to smooth out. Dr. Bernard will be happy to provide you with detailed and competent advice on the procedure.