Lymphatic Reconstructive Surgery (LRS) is rapidly evolving over the last 15 years, but it is still an adjunct in the management of Lymphoedema. LRS depends on whether the affected limb is predominantly fluid, or fat – Physiological procedures for Fluid and Debulking procedures for fatty tissue. Whilst the domain of treatment still is lifelong complex decongestive therapy, it is more and more widespread to treat the disease with a surgical focus on physiologic, reconstructive strategies or debulking surgery. Lymphovenous Anastomosis (LVA) and Vascularized lymph node transplantation (VLNT) are the mostly frequently applied, physiological reconstructive techniques which address restoration or improvement of physiologic lymph clearance. Debulking procedures involve removal of lymphoedematous tissue via liposuction or excision of tissue. Liposuction is performed when the affected limb is predominantly composed of fatty tissue. In rare situations, resection and reconstruction of entire lymphoedematous tissue could be the only option.