I might have a lipoma and I am just curious about what kind of lipoma treatments exist. Is surgery the only option for lipoma removal or do people with lipomas have other options?
What Are my Lipoma Treatment Options?
Doctor Answers (12)
What are my lipoma treatment options?
These benign fatty tumors are removed because they are unsightly, uncomfortable or enlarging.
These tumors are typical in appearance: soft to rubbery, not fixed to skin or underlying structures, and slow growing. If there is skin change, ulceration, dimpling or fixation, they should be biopsied to rule out a malignant liposarcoma. Liposarcomas of the skin are usually intradermal and not like lipomas. Liposarcomas arising as malignant tumors are found most often in deeper tissues such as muscle or in the back of the abdomen.
Malignant transformation of a lipoma to a liposarcoma is rare. If there is concern about a lipoma being malignant, then an excisional biopsy or fine needle biopsy can be done.
Once the decision is made to remove the lipoma, it can be done by direct excision which leaves a scar of varying length; liposuction, which will leave some cells behind, or laser melting which may also leave some cells behind. However, this does not occur so often as to be an inconvenience, since the lipoma is slow growing and another procedure can be done. Removal through laser or liposuction, my preference being laser, leaves only a 5 mm scar which can be remote from the lipoma and hidden in a skin crease if possible.
If a patient has multiple small lipomas,which many do, on the arms, chest, trunk and legs, surgical excision leaves so many scars that patients want an alternative, less scarring treatment, even if it does have some trade-offs. Even debulking multiple lipomas without complete removal is worthwhile because it is not disfiguring. Many patients with familial lipoma histories keep getting lipomas. This problem can be controlled with laser melting.
Lipoma surgery excision
Lipoma removal is usually a simple procedure under local anesthesia. Majority of lipomas can be removed like an "marble" from a small incision. This takes about 5 minutes to perform. As a dermatologist and cosmetic surgeon I close the incision with disolvable sutures so there are no sutures outside for the best cosmetic result. There are some Lipomas that are larger and more fibrous and attached which require more work. The cost for removal is about $100.
Lipoma removal options
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Treatment of lipoma
A lipoma is a benign (non-cancerous) fatty tumor which can appear almost anywhere on the body. They are usally firm and round and can become unsightly, requiring removal primarily for cosmetic reasons. Most can be removed under local anesthesia as an outpatient with minimal pain and quick recovery. The specimen should be sent to a pathology lab to confirm the diagnosis. They are usually removed by plastic surgeons or dermatologists. The entire lipoma, including it's outer lining, must be removed to prevent recurrence.
Please consult with a board certified surgeon prior to your lipoma removal.
Lipoma Size is Key - as well as MRI features
Surgeons are taught to be suspicous of lipomas when their size exceeds 5 cm. Of course, the best course is to resect ( excise) the lesion and send it to the pathologist for review. Giving the pathologist a soupy specimen with fat cells in it does not make it possible to determine if you removed the whole thing, especially if liposuction was used. It could potentially tell the pathologist that there were malignant cells. That is not very helpful in of itself. Could you have left some of those cells in the body? Of course, that is a very important consideration.
In a recent article that looked at MRI features for cancer in lipomas, the authors found that "no single MIRI feature was diagnostic for any soft tissue tumors. However, three individual MRI features were statistically significant for differentiation between benign and malignant soft tissue masses (p < 0.05). The features that favor malignancy were heterogeneous signal on T2-weighted, perilesional edema or invasion, and necrosis in the masses".
"Buyer beware" when you sign up for procedures that are not standard of care, such as liposuction for lipoma. Liposuction should be reserved for cosmetic procedures, not soft tissue masses.
Treatment Options for Lipomas
Surgery is the best option for lipoma removal. Liposuction has been used, but in my opinion it is a less optimal choice as some of the cells which constitute the lipoma may be left behind (and therefore, the lipoma may recur). Many lipomas can be removed with a relatively small incision so its important to discuss with your doctor how the surgery will be performed and how large the surgery scar will be.
Excision is the best treatment for lipomas
Lipomas are soft and the localized areas of fatty growth. As lipomas lived deep to the skin, treatments such as creams or lasers will have no effect on them. If the lipoma is concerning you and you would like it removed, the best treatment is surgical excision through a small incision that is placed in an inconspicuous area so that it is not easily noticeable and heals well.
Lipoma surgery is most common treatment
Lipomas are benign fatty tumors composed of adipocytes (fat cells). The most definitive treatment for a lipoma is surgical excision using a very small incision placed on the skin. This is a common procedure that I perform in an outpatient setting.
Lipomas are usually removed because of a change in characteristic (i.e increase in size), compression of a critical structure (i.e. compresses a nerve) or for aesthetic reasons (i.e. don't like how it looks). Frequently, they can be excised easily. Liposuction of lipomas is possible, but increases the chance that they will regrow since they are not removed completely. In rare situations, a mass that is suspected to be a lipoma turns out being a malignant (cancerous) mass. This is why any suspected lipoma should be biopsied and assessed microscopically by a pathologist.
Surgery versus observation
When you say you have a lipoma, you are more often than not guessing. Unless the lump has been at least partially removed and examined by a pathologist you are not absolutely sure.
Surgery to remove lipomas can be simple. Some try to make it more complicated. It is a matter of philosophy. I usually remove them via conventional surgery and offer to send them for pathology. Afterward I do a little plastic surgery to encourage the operative wound to heal the best it can.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.