Liposuction, lipectomy, or combined techniques for Madelung's disease: A systematic review

Madelung's disease (MD) is a rare disorder with progressive, symmetric, non-encapsulated adipose deposition, predominantly in the cervicothoracic region. Surgery, lipectomy, liposuction, or combined procedures is the main treatment, but comparative outcome data remain limited.

A PRISMA-compliant systematic review (PROSPERO CRD420250627795) was conducted using the PubMed/MEDLINE, EMBASE, and Web of Science databases (through July 2025). Studies reporting surgical treatment of MD with lipectomy, liposuction, or combined techniques were included.

Seventy-seven studies included 436 patients; 76% (n = 332) were men with a mean age of 49.8 ± 8.7 years. Cervicothoracic involvement was described in 75% (n = 326), and a typical "Madelung's collar" in 74% (n = 322). Lipectomy, documented in 56% (n = 245), was primarily used for extensive or fibrotic disease, with reported functional improvement in 19.6% (n = 48), esthetic improvement in 26.9% (n = 66), psychological benefit in 20.4% (n = 50), and recurrence in 15.9% (n = 39). Liposuction, described in 13% (n = 56), was mainly used for superficial disease, with reported esthetic improvement in 60.7% (n = 34), psychological benefit in 41.1% (n = 23), recurrence in 12.5% (n = 7), and conversion in 12.5% (n = 7). Combined procedures (6.2%, n = 27) were associated with reported functional improvement in 55.6% (n = 15), psychological benefit in 48.1% (n = 13), and recurrence in 18.5% (n = 5).

The available evidence supports an anatomy-based, individualized surgical approach to MD, reflecting variation in disease extent and surgical indications. However, comparative conclusions are limited underscoring the need for future research.