Antibiotics Necessary Before or After Lipoma Excision?

There is very clear evidence in some of the general surgical literature that there is little benefit, if any, to administering antibiotics during the majority of clean cases. In plastic surgery, the majority of the cases are clean. However, there are exceptions to this antibiotic rule in two very common situations.

1) The first is when a sterile foreign body is being implanted (i.e. breast implants).

2) The second is when there is extensive undermining of the soft tissues that creates what is known as "surgical dead space."

In these types of cases, there is a high propensity for the collection of fluid which could potentially become infected. For these reasons, prophylactic antibiotics are given in these types of cases. If you have severe drug allergies to many antibiotics, then you may be better off not taking antibiotics upfront; instead reserve them for use should you develop an infection after surgery.

As long as the lipoma removal surgery is performed under sterile technique, there is no real clinical reason to administer antibiotics before or after the procedure. Some dermatologic surgeon or plastic surgeon may choose to do so if the wound is large or the procedure takes longer than expected. Indiscriminate prescribing of pre-op and post-op antibiotics is no longer endorsed by most dermatologic and plastic surgeons.

Dear Tark, "Clean" skin surgeries do not typically require antibiotics. Assuming there is no active infection in your skin or around the lipoma we can typically avoid giving antibiotics.Stephen Weber MD, FACS