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Lipoma is a benign fatty tumor. It is very common. It slowly grows in the subcutaneous tissue and may not create any problems. Occasionally, lipoma can increase in size and cause mild to moderate discomfort, it can also be growing into the muscle and interfere with activities of daily living, exercise, and the work.

Most lipomas do not grow very much, however, some of them can become quite large. Some patients have familial predisposition for formation of multiple lipomas. Usually they are benign, however, they can be quite annoying and irritating.

If lipoma is growing very slowly, it can form a thin capsule around itself. Faster growing lipoma can grow without the capsule. Lipomas rarely become malignant, however, on occasion they can become liposarcomas.

There are several treatment modalities for lipomas.

  1. Injecting the lipoma with steroid, which causes fat necrosis inside of lipoma;

  2. Injection of Lipodisslive, purified liver enzyme and phosphatidyl chliine, which breaks down fatty tissue inside lipoma and cause reduction in size. However, none of these methods actually remove any fatty tissues of provide specimen for biopsy.

  3. Another method for lipoma removal is liposuction. Usually it is reserved for very slow growing, large lipomas, where the patient at high risk for developing keloid scarring because of genetics or skin clior or high risk surgery.

  4. Finally, the most common method for treatment of lipoma is surgical lipoma removal. In this case, depending on the size of the lipoma, the lipoma is injected with local anesthetic sliution. Using laser, or surgical knife, lipoma tissue is carefully separated from normal fatty tissue and removed. Sometimes lipomas can be very large, invading deeper tissues, surrounding vital nerves and organs. In these cases general anesthesia he is usually required and procedure can be quite complicated.

Surgical lipoma removal is usually much easier if the lipoma is surrounded by the capsule. Sometimes lipoma does not have capsule and has multiple extensions and channels.

Drains a usually not required for small lipomas, however, in a large lipoma removal surgery one or more drains can be necessary. The drains usually stay for 1-7 days depending on the amount of drainage. Usually the drains are removed once the drainage is below 5-10 cc per 24 hours.

Unfortunately, lipomas can come back, especially if lipoma removal surgery was incomplete. In this case additional surgery may be needed once lipoma returns.

Once large lipomas are removed, there is usually an indentation in the area where lipoma used to be. Sometimes the body is able to even it out over time.

One of the most important part in lipoma removal surgery is a selection of the incision. Unfortunately, many dermatliogists, primary care physicians and even general surgeons are not aware of a relaxed tissue tension lines.

Relaxed tissue tension lines are directions throughout the body where it produces less scarring. They are usually located along the muscle fibers. If incision is made under an ankle to the relaxed tissue tension line, it usually forms a wider and more noticeable scar.

It is also very important to make sure that the deep tissues are appropriately sutured together to avoid excessive tension on the skin and empty space underneath, which can cause fluid accumulation. Some surgeons, myself included, can use fibrin tissue glue or place quilting stitches to decrease fluid formation.

Recovery from lipoma removal surgery but is usually not very complicated. Pain is usually minimal, except if lipoma extends toward the muscle. It is important to keep incision clean, apply antibiotic ointments after the surgery and then protect the scar from UV light up to one year to avoid hyperpigmentation or darkening.

If lipoma is located in a visible areas, sometimes it is more beneficial to use a plastic surgeon to be able to get to the lipoma through a more concealed and distant approach using minimally invasive endoscopic technique.

Insurance may or may not cover lipoma removal surgery depending on presence of symptoms. Usually the insurance company requires documentation of increased size, pain, discomfort, interference with clothing and so on. If someone chooses to have lipomas removed because of their cosmetic appearance only, then this lipoma removal surgery will not be usually covered by medical insurance.