Lymphoedema is a chronic debilitating disease resulting from an abnormal collection of protein-rich fluid within the subcutaneous tissues. It may be due to aberrant development or malfunction of lymphatic channels or from permanent damage to a normal lymphatic system. Whatever the cause, it is due to an imbalance between capillary filtration and lymph drainage. Initial presentation is with limb swelling, heaviness and pitting. As the disease progresses, fibrosis and fat deposition occur. Developments in near-infrared spectroscopy, lymphoscintigraphy and MR lymphangiography have reinvigorated the role of imaging. Conservative measures are the mainstay of treatment designed to manage the condition rather than to provide a cure. Physiological and reconstructive surgical procedures may improve the lymphatic function of the limb, whereas excisional techniques debulk the limb. Surgical results have been variable and difficult to assess in terms of efficacy. There is a clear need for an unbiased scientific assessment of these techniques with further research.