What is a Lipoma?
A lipoma is a very common benign fatty tumor that slowly grows in the subcutaneous tissue, seldom causing any major side effects. Occasionally, a lipoma can increase in size and cause mild to moderate discomfort, it can also grow into the muscle and interfere with the activities of daily living.
Most lipomas do not grow very large, however, some of them can reach a substantial size. Some patients have a predisposition due to family history for the formation of multiple lipomas. Usually they are benign, however, they can be quite irritating.
If a lipoma is growing very slowly, it can form a thin capsule around itself. Faster growing lipomas can grow without the capsule. Lipomas rarely become malignant, however, on occasion they can become liposarcomas (cancerous lipomas).
- Injecting the lipoma with a steroid, which causes the fatty tissue to break down inside of the lipoma;
- Injection of Lipodissolve, a combination of purified liver enzyme and phosphatidyl choline, which also breaks down fatty tissue inside the lipoma and causes a reduction in size.
- Both of these methods do not remove any fatty tissues or provide a specimen for biopsy.
- Another method for lipoma removal is liposuction. This is usually reserved for very slow growing, large lipomas where the patient is at a high risk for developing keloid scarring due to genetics or skin color or is a high risk to undergo a surgical procedure.
- Finally, the most common method for treatment of a lipoma is surgical removal. In this case, depending on the size of the lipoma, it is injected with a local anesthetic solution. Using a laser, or a small surgical knife, the lipoma tissue is carefully separated from normal fatty tissue and removed. Sometimes lipomas can be very large, invading deeper tissues, and surround vital nerves and organs. In these cases, general anesthesia is commonly required and the procedure can be quite complicated.
Risks and outcomes of lipoma removal:
Surgical lipoma removal is usually much easier if the lipoma is surrounded by a capsule (scar tissue that forms a thin shell-like structure around the tumor). In some cases, a capsule is not formed around the tumor causing it to form multiple extensions and channels into the surrounding tissue and organs.
Drains are usually not necessary for small lipomas. However, when a large lipoma is removed, one or more drains may be necessary to prevent the accumulation of fluid in the tissue. The drains usually stay in for 1-7 days depending on the amount of drainage. The drains are usually removed once the drainage is below 5-10 ccs consistently for 24 hours.
Unfortunately, lipomas can re-generate, especially if the lipoma removal was incomplete. In this case, additional surgery may be needed.
Once large lipomas are removed, there is usually an indentation in the area where lipoma used to be. Sometimes the area evens out as the healing process continues.
Recovery from lipoma removal surgery is minimal. Pain is nominal unless the muscular tissue near the tumor is involved. It is important to keep incision clean, apply antibiotic ointment after the surgery, and protect the scar from UV light up to one year to avoid hyperpigmentation or darkening.
Why would I see a plastic surgeon for a lipoma removal?
One of the most important factors in lipoma removal surgery is the incision. Unfortunately, many dermatologists, primary care physicians, and 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. For example, if the 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 brought back together with sutures to avoid excessive tension on the skin or creating an empty space underneath, which can cause fluid to accumulate in the space. Plastic surgeons, myself included, can use fibrin tissue glue or place a special quilting stitch to decrease fluid formation.
If a lipoma is located in a visible area, it is also more beneficial to go to a plastic surgeon. Plastic surgeons are trained to remove the tumor through a minimally invasive incision with a special technique.
Does my insurance cover the removal of lipomas?
Insurance may cover this type of surgery depending on presence of symptoms. Usually an 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 the surgery is considered a cosmetic procedure, therefore not covered by their medical insurance coverage.
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