Definition & Overview
Lipomas are slow-growing tumours that often develop in the subcutaneous tissues. They most commonly form in the head, neck, shoulders, and back and can occur in patients of any age but are more common among older people aged between 40 and 60. Lipomas can also occur in groups. Clustered lipomas occur more often among men, while solitary ones are more common among women.
Most lipomas are benign and asymptomatic, and present as round, soft, and doughy masses. In the majority of cases, the masses are not painful, and can be left alone without treatment. However, in cases wherein lipomas become painful or grow too fast and too big, they are removed through a procedure called lipoma excision.
Who Should Undergo and Expected Results
Although not all lipomas require treatment, their removal is recommended if:
- The patient experiences pain or other symptoms
- The mass is growing too fast
- Its size and location cause complications
- The patient wants it removed for cosmetic reasons
- Liposarcoma or malignancy is suspected
Lipoma excision can be performed on any kind of lipoma, including:
- Neomorphic lipomas
- Spindle cell lipomas
Some lipomas are also linked to underlying medical conditions, most of which are hereditary. These include:
- Hereditary multiple lipomatosis – This is an autosomal dominant medical problem that causes symmetrical lipomas to spread out over a large portion of the body.
- Adiposis dolorosa – Also known as Dercum’s disease, this refers to the formation of irregularly shaped and painful growths on the trunk, shoulders, and limbs.
- Gardner’s syndrome – This is characterised by the growth of abnormal cysts and tumours including lipomas, intestinal polyposis, and osteomas.
- Madelung’s disease – Also known as benign symmetric lipomatosis, this causes lipomas to form in the head, neck, shoulders, and proximal upper extremities. If the lipomas occur in the neck, they may cause difficulty swallowing and respiratory obstruction. In severe cases, they may also cause sudden death.
When compared to other treatment options, such as steroid injections, lipoma excision is the most effective, as it can get rid of the abnormal growth completely.
How is the Procedure Performed?
Before a surgical lipoma excision, the surgeon draws an outline on the patient’s skin to mark the location of the lipoma. The anaesthesia is then administered in a 1-2 percent lidocaine with epinephrine concentration. The affected skin is also cleansed with povidone iodine or chlorhexidine.
If the lipoma is very small, the surgeon will make a 3mm to 4mm excision in the skin over it to place a curette inside the wound. Using the curette, the surgeon will begin to free the lipoma from the tissues that surround it, and then enucleated through the cut. Since the incision is very small, sutures are not necessary and the surgeon may simply put a pressure dressing over the wound.
If the lipoma is large, the surgeon will make a larger incision (usually just a little bit smaller than the lipoma) that follows the skin’s tension lines. A hemostat or Allis clamp is then used to provide skin traction. From the opening, the surgeon begins to dissect through the subcutaneous fat using a scalpel to reach the tumour underneath, while making sure to avoid the nerves and blood vessels in the area. If the cut is large, the surgeon ends the procedure by suturing the incision closed.
The patient will then be asked to return within 2 to 7 days after the procedure to have the wound checked. The sutures, if non-absorbable, will be removed 7 to 21 days after the procedure, depending on where the cut was made.
As a modern alternative, lipomas can also be removed through non-surgical endoscopic excision. This is usually performed on lipomas that are located in the deepest tissues, the internal organs, or other hard-to-reach areas, such as the eosophagus, stomach, or colon.
Possible Risks and Complications
Lipoma excision may cause some complications, which include:
- Surgical infection
- Hematoma formation
- Injury to nearby nerves or blood vessels
- Permanent deformity (in the case of large lipomas)
- Muscle irritation leading to injury
- Fat embolus
- Severe scarring following the removal of large lipomas
Salam G.A. “Lipoma Excision.” Am Fam Physician. 2002 Mar 1;65(5):901-905. http://www.aafp.org/afp/2002/0301/p901.html
Nickloes T.A. “Lipomas Treatment and Management.” Medscape. http://emedicine.medscape.com/article/191233-treatment#d10