For years, women with lipoedema have been told that the surgery that removes diseased lipoedema tissue is ‘cosmetic’. In Australia, that label is the reason it has no MBS item number. Medicare deems liposuction ‘cosmetic and elective’, despite item number 45585 covering liposuction for conditions like lymphoedema, and items 31525 and 31526 covering liposuction for male gynaecomastia (breast tissue reduction).
So for women with lipoedema, there’s no Medicare rebate, no private health cover, and women pay anywhere between $15,000 to $150,000 for the surgery themselves.
In September 2026, The Lancet published the strongest evidence yet that the cosmetic label is wrong. The LIPLEG trial is the first large randomised controlled trial to compare liposuction with conservative therapy for lipoedema.2 The outcome it set out to measure was pain.
The trial enrolled 410 women with lipoedema of the legs, at Stages 1 to 3, across 11 centres in Germany. Every woman had leg pain of at least 4 out of 10.
All of them first received conservative therapy, such as compression and manual lymphatic drainage. One group then had liposuction, and the other continued with conservative therapy alone. The team assessing the results did not know which treatment each woman had received.
A randomised controlled trial is the strongest kind of evidence in medicine, and it is the kind that funding bodies such as Australia’s Medical Services Advisory Committee look for when deciding what to fund.
Surgery is not risk-free, and it’s not right for every woman. But a treatment whose benefit is measured in less pain, better movement and a better quality of life is a medical treatment.
For the Australian women that would experience improved health outcomes as a result of this surgery – it should be a funded option, just like lymphoedema surgery, or gynecomastia surgery.
The LIPLEG trial didn’t come out of nowhere – clinical experts in the United States and Germany had already reviewed the evidence and recommended surgery for painful lipoedema.
The Standard of Care for Lipedema in the United States, a consensus of clinicians and researchers published in 2021, states plainly: “This is not cosmetic liposuction as there are mobility, pain and health benefits when removing lipedema tissue”. It says surgery “significantly improves symptoms“, including mobility, stance and gait, and “also improves lymphatic symptoms, reducing the need for compression and manual therapy“. It also describes surgery as “currently the only available technique for removing abnormal lipedema tissue“.
Germany’s S2k guideline on lipoedema, published in 2024, was developed by specialist societies in phlebology, lymphology, dermatology, vascular surgery and plastic surgery, with a patient representative. It describes lipoedema as “always painful” and recommends that “Liposuction shall be used as surgical method of choice for the sustainable reduction of the affected subcutaneous adipose tissue of lipedema on legs and arms.” It says the decision to operate should no longer depend on the stage of the disease, because stage does not reflect how severe the symptoms are. And it reports that liposuction “results in pronounced improvements of spontaneous pain, pressure pain, and susceptibility to hematoma”, and “may permanently alleviate pain and improve the quality of life“.
Both guidelines are also clear about safeguards: conservative therapy first, experienced surgeons, and honesty about the risks. LIPLEG now provides randomised evidence for what these guidelines already recommend.
On 17 July 2025, Germany’s Federal Joint Committee (G-BA), which decides what German public health insurance covers, ruled that liposuction for lipoedema would be covered at all stages. The decision was based on first results from the LIPLEG trial. Until then, cover had been limited to Stage 3.
A woman in Germany now qualifies after six months of conservative therapy without enough improvement, and any significant obesity must be treated first. Quality rules also apply to the doctors who diagnose and operate, to surgical planning and to follow-up. It is a working model of how a funded pathway can be built with clear safeguards.
The published results cover 12 months – the trial will follow the women for 36 months, which will show whether the benefit is lasting2. An earlier study that followed women for up to 12 years after liposuction found lasting reductions in pain and less need for compression and lymphatic drainage.
Whether surgery slows the disease is still debated. The US consensus describes surgery as “the only treatment that slows progression of lipedema”, based on observational evidence. Germany’s guideline takes a more cautious view, and says lipoedema should not be seen as generally progressive, because progression depends on factors such as weight gain and hormonal change5. The 36-month LIPLEG results will be the first randomised evidence on this question.
We now have a randomised trial, two expert guidelines and a national funding decision overseas all pointing the same way. Yet here, the surgery is still labelled cosmetic and tax-paying women still pay the full cost.
Two changes would make a real difference:
I’ve shared this evidence with the Senate Select Committee on Women’s Health, which is looking at women’s pain, medical misogyny and the cost of treatment.
More than a million Australian women are estimated to have lipoedema. Medicare has no item number for the surgery that treats it, so women pay the full cost themselves.
Could your skincare and activewear be affecting lipoedema progression? New research on endocrine-disrupting chemicals reveals surprising connections between everyday products and hormone-driven adipose disorders. Evidence-based guidance for reducing exposure.
Navigating the complexities of lipoedema with Dr Avi Charlton (Prescribing Lifestyle Prodcast) and Toni Morrow (Navigating Lipoedema)