Large Lipoma Removal - Surgery or Liposuction?

I have a large (abt the size of a small lime) lipoma on my upper thigh. I just saw a general surgeon who said it could be removed via surgery (with a drain, leaving an indentation & scar, with a recovery period >= 1 week, covered by insurance) or via liposuction (no drain, no indentation, minimal scar, & not covered by insurance, abt $2500), with about the same long-term risk of it recurring. I don't care too much about the scar, but the indentation worries me. Any thoughts on which way to go?

Doctor Answers (2)

Large Lipoma Removal - Surgery or Liposuction?

+1

My approach to remove a lipoma the size of a lime, about 5-6 cm in diameter, would be laser assisted removal. A reference is included.

While lipomas are commonly removed with surgery, involving an incision and direct dissection around and under the lipoma, I have been using the Smartlipo Triplex, computer controlled, 1440 nm wavelength laser for several years. The 1440 wavelength has a high affinity for fat and melts the lipoma very nicely. It does not remove the stromal or fibrous tissue, so that is removed by gently grasping with a narrow alligator clamp introduced through the access incision that is about 3/8" long.

For a lipoma the size of a lime, I would insert a seroma cath drain to collapse the cavity and get the surfaces to adhere without fluid accumulation. The drain would remain for 3-5 days.

I have used liposuction in the past, before I had the laser, but I found the risk of recurrence was greater. One of the drawbacks of using only liposuction is that normal subcutaneous tissue can also be removed and thus, there is the risk of a persistent depression of the area treated. This does not seem to be a big problem, if the suction is turned to low, 15-18 mm Hg, rather than full suction, and if a relatively small cannula, 1.5-2.5 is used carefully.

I use the code for excision of a subcutaneous lesion, and insurance has been covering some portion of the cost for patients if they have met their deductible. It is the same thing as removing a subcutaneous lesion, but less traumatic and with minimal scarring.


Mountain View Plastic Surgeon
5.0 out of 5 stars 26 reviews

Lipoma Removal

+1

Hello Jeri,

Liposuction is not as effective as surgical removal for Lipomas. The risk of incomplete removal and recurrence is much higher. The indentation is due to the large space that is left after removal of the lipoma. This indentation often resolves with time as your body's tissues grow into the cavity. I have removed many lipomas without drains and with excellent results without indentation. Good luck to you!

Michael A. Zadeh, MD, FACS
Sherman Oaks General Surgeon
5.0 out of 5 stars 3 reviews

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