What is a lipoma?
Lipoma is the most common benign tissue tumor that occurs in almost 1 percent of the population. A lipoma consists of mature fat cells. Typically, a lipoma is enclosed by a thin fibrous capsule. Usually, lipomas develop superficially under the skin, but they can also occur anywhere in the body. Lipomas are painless and are usually seen on the shoulders, arms, upper back, buttocks, and upper thighs.
Lipomas are not cancerous. Treatment for lipomas is not usually necessary unless it is bothering you.
Causes of Lipoma
It is speculated that previous trauma is the cause of lipoma. According to one theory, body fat can protrude through tissue planes due to injuries, which then creates a "pseudo" lipoma.
Another theory suggests that cytokines are released due to trauma. The release of cytokines is said to cause the abnormal growth of fat cells.
However, there is still no evidence, which shows that trauma can cause lipomas. The exact cause of lipoma is not yet completely understood, but a genetic link to solitary lipomas was found on chromosome 12.
Advantages of Lipoma Removal
Lipomas are surgically removed for the following reasons:
- It causes a cosmetic deformity.
- The lipoma mass is larger than 5 cm.
- It causes pain, limitation in motion, and numbness.
Lipomas are usually benign, but sometimes, they can be painful and uncomfortable. Although they are not life-threatening, they tend to grow deeper and push on the nerves, which can sometimes interfere with daily activities. To confirm whether the lipoma is cancerous or not, the fatty tissue is further analyzed after its removal.
Nonexcision Techniques for Lipoma Removal
1. Steroid Injections
Steroid infections cause local fat atrophy leading to their shrinkage or elimination. Injections are best performed on lipomas that are less than 1 inch in diameter.
A dosage of 10 mg/mL of 1:1 mixture of 1 percent Xylocaine (lidocaine) and Kenalog (triamcinolone acetonide) is injected into the lesion. The procedure may be done several times at monthly intervals. The amount of steroid given usually depends on the size of the lipoma. Moreover, the number of injections depends on the result, which can be seen within 3-4 weeks.
Although complications are rare, they can be prevented by injecting the smallest amount possible and by correctly positioning the needle at the center of the lipoma.
2. The Liposuction Method
Liposuction can be used for medium-sized and even larger lipomas. The drawback of liposuction is that residual fat may be left behind. Thus, there is an increased chance of the lipoma to regrow. Moreover, a complete evaluation of the entire tumor cannot be done through liposuction. If the lipomas are large, smaller incisions can be done in liposuction. Although the liposuction method is less invasive, the total removal of fatty tissues cannot be guaranteed.
Surgical Removal: Preparation for Excision
Prior to surgery, drawing an outline of the lipoma on the skin and the planned excision using a marker is often helpful. The outline can help map out the margins, which could become unnoticeable after anesthetic administration.
The skin is disinfected using Betadine (povidone-iodine) or Betasept (chlorhexidine). Any skin markings should not be wiped away. The area is draped with a sterile towel. Local anesthesia is administered using 1-2 percent lidocaine with epinephrine.
- Enucleation - Small lipomas can be removed through enucleation. A 3-4 mm incision is made and a curette is placed inside the wound to free the lipoma from the surrounding tissues. The tumor is enucleated using the curette. Generally, sutures are unnecessary. A pressure is dressing is then applied to prevent the formation of a hematoma.
- Excision - Larger lipomas can be removed by making incisions in the skin overlying the lipomas. Dissection is performed beneath the subcutaneous fat.
Preparation Before Lipoma Removal Surgery
- It is recommended to discontinue taking medications that can increase the chances of bleeding prior to surgery.
- Blood tests should be performed. Blood tests will help determine if the patient has any medical condition and whether the lipoma removal procedure should be performed or not.
- The patient must inform the doctor in advance if he is allergic to lidocaine or any local anesthetics.
- Any cosmetics, topical medications, and deodorants should be avoided before starting the procedure.
- Do not use any nicotine-based products. Quit smoking before the surgery.
- Avoid the consumption of alcoholic drinks for a period of time.
- Avoid eating or drinking at least eight hours before surgery. It also depends on when the procedure will start and the type of anesthesia used.
Local anesthesia is usually administered for a lipoma removal surgery. The surgery can be performed for nearly 30 minutes. The duration of the surgery also depends on the method of removal along with the size and number of lipomas.
The size and location of the lipoma will determine the type of anesthesia to be used. There needs to be a mutual agreement between the surgeon and the patient regarding the administration of anesthesia.
Rest and Recovery
The individual can go home once the procedure is done. The procedure is usually completed in just a few minutes. The time required for recovery will depend on the size and location of the lipomas. Usually, patients can resume light activity and return back to work after a week.
To ensure that the wound is properly healing, the patient should return for a postoperative visit. Regardless of the method used for lipoma removal, a sample of fatty tissue is sent to the laboratory to test whether it is cancerous or not. Although lipomas are noncancerous, it is better to ensure the safety and good health of the patient and take precautions.
The cost of surgery depends on a variety of factors. Before the procedure, the patient is given an estimate of the procedure. However, the actual final amount is dependent on the findings during the procedure or the surgery and the care that will be needed after the operation.
Complications of Lipoma Removal
The following complications are involved in lipoma removal:
- Surgical infection
- Vascular compromise or injury to nearby blood vessels
- Permanent paresthesia or injury to nearby nerves
- Permanent deformity secondary to removal of a large lesion
- Muscle injury
- Excessive scar contractures
- Fat embolism
What are other things involved?
- Cost - Includes factors such as health insurance, co-pay requirements, out-of-network, and in-network of healthcare providers and healthcare facilities. Annual deductibles will determine the cost of the lipoma removal surgery.
- Consent Process - A consent form is signed after reading and discussing the possible risks and benefits related to the treatment option. This is also known as an informed consent. You can sign the consent but only after a thorough discussion with your doctor. In case of people who cannot give consent such as minors, a legal guardian on their behalf should sign the consent.
- Tests Prior to the Procedure - All patients undergo specific tests before undergoing a lipoma removal procedure. Tests include routine blood testing and urinalysis. If the physician finds it necessary, he or she may ask for imaging modalities.
Risks and Complications
- Advanced age
- Poorly controlled diabetes (a high fasting glucose with a high hemoglobin A1c)
- Impaired kidney function (elevated levels of creatinine and blood urea nitrogen in the blood)
- Decreased liver function (abnormal results in liver function tests)
- Hypertension or high blood pressure
- Malnutrition, vitamin deficiencies, or poor nutritional status
- History of bleeding disorders
- Poor lung function (abnormal lung function tests)
- Long-term illnesses such as chronic infections and autoimmune disorders
- Weak immune system
- Excessive bleeding
- Infection around the surgical wound