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Lipoma

Lipomas are benign and generally harmless tumours of fat, and as such may occur anywhere in the body where there is fat. Most are visible swellings under the skin causing only a cosmetic problem. Deeper ones, particularly growing within confined spaces, may cause problems by pressing on other sensitive organs. Pressure on nerves in the carpal tunnel at the wrist or spinal cord are particular issues.

Typically, they are soft, rubbery, moveable lumps protruding from the skin with little or no pain. They grow slowly and range in size from that of a pea up to enormous.

Lipomas are most commonly found on the arms, shoulders, upper back, chest, thighs and buttocks. However, lipomas can be found anywhere where fat cells are present. Lipomas are most common in middle-aged men and women in equal proportions. These benign tumours have a slight tendency to run in families, so, if there are one or more people in your family with a lipoma, your chances of developing one increase significantly.

There is one group of patients who strongly inherit the condition of Familial Multiple Lipomatosis as a dominant gene. 50% of children are affected. These people may develop 10s or hundreds of lipomas. Surgeons see a lot of these patients, as although the condition not so common, one might remove 10 lipomas at a time and, before long, patients are back for removal of another crop.

Lipomas are caused by an overgrowth of fat cells. When we look closely, we can see that they are made up of large normal looking fat cells arranged as lobules within a fibrous capsule.

Treatment may be for cosmetic reasons, but some are painful, and a small number become malignant. The problem is that it is impossible to make the diagnosis of a malignant lipoma, the liposarcoma, without checking it under the microscope. There are certain signs that could be a problem. If they are large, growing fast, painful or in an unusual place, such as deep in the muscle. For this reason, one should always arrange for lipomas removed to be checked histologically. Even then, diagnosis may be difficult, as many tumours are only on the edge of malignancy and slow growing. Later they may become more aggressive.

Treatment is surgical, mostly by surgical excision. Those, that are under the skin where there is little normal fat, such as the limbs, pop out quite easily, often through a tiny stab incision. Deeper ones are often more diffuse and less easy, but still possible to carry out under local anaesthesia. There are variants, where other tissues occur in the fat, as for instance blood vessels. These angiolipomas are common and not much extra trouble. Those occurring on the nape of the neck are fibrous and diffuse and difficult to remove completely, not that that really matters.

We, at the Cadogan Clinic, use the tiniest incisions. This makes the procedure smaller and, of real importance, means we can remove lipomas on cosmetic grounds as we will not leave a scar looking worse than the lipoma! Do discuss this point with your surgeon.

We do not want our scars to show.

Liposuction can be used to remove or reduce larger lipomas. The stab incision can be hidden remotely. The drawback is that histology is more difficult. One wants to know that this lipoma is not malignant. In addition, one will not remove all the lipoma, making recurrence more frequent.

Lipomas may recur if not completely removed. Even with excision, it is easy to leave a lobule behind. Where people have multiple lipomas, it may just be a new one appearing.

You have the choice, but most lipomas are removed under local anaesthesia. General anaesthesia at the Cadogan clinic, TIVA (Total IntraVenous Anaesthesia), is easy and does not leave you sick and slow to recover.

 

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Mr. William Van Niekerk
Mr. William Van Niekerk

Plastic Surgeon

A plastic, reconstructive, aesthetic and burn surgeon specialising in all areas of cosmetic surgery, non-surgical aesthetics and complex microsurgery

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