When lipomas are removed there is a void--an empty space that should be filled. A plastic surgeon utilizes techniques like "undermining" and "multilayered suturing" in order to pull the deeper layers over the bare bone and fill in the deficit. Usually these techniques fill the hole in very well and allow for normal movement and appearance of the overlying skin. When the deeper tissues (fat, muscle, fascia) are pulled together they act as a "spacer" that prevents the skin from sticking down to the bone. Unfortunately, not everyone heals the same, and sometimes the sutures don't hold or the deeper tissues tear and retract, leaving a depression, and without the spacer the skin may stick down to the bone. Thankfully this can be corrected, but usually requires a second procedure. There are 2 common ways we approach this: 1) fat injection or 2) dermal fat graft. Fat injections involve sucking some fat from another area of the body (often through a small incision in the belly button) and then injecting the fat with a needle between the skin and bone on the forehead. Sometimes this procedure needs to be repeated a second time to get enough fat in place. A dermal fat graft is a little different. It involves excising a small piece of skin and fat from somewhere else on the body, removing the upper layers of the skin (the epidermis), leaving you with a "dermal fat graft". The scar from the lipoma is re-opened, the dermal fat graft is sutured over the bone, and then the skin is closed back over the graft. I hope this helps!
Seromas can be an annoying complication following surgical procedures. They occur more often following procedures on fatty tissues (i.e. liposuction, tummy tucks, removal of lipomas, breast surgery). To reduce seromas, high risk procedures utilize postoperative drains, compression dressings, and/or "quilting" or "3-point" sutures to close and compress the cavities created by those procedures. When seromas do develop, first-line treatment is often drainage by needle aspiration and compression. Sometimes aspiration needs to be repeated multiple times, but hopefully there is a trend towards less and less fluid. In the rare case that a seroma doesn't resolve, there are some alternative options. In our practice, during the first 1-3 weeks we will sometimes drain the seroma cavity and inject a medicine called Doxycline into the cavity. This can be a little painful because it agitates the seroma cavity, but hopefully helps it seal off. We will sometimes repeat this injection. When these steps fail to resolve the seroma, we consider surgical options. As the seroma matures, it develops a sac or wall. Surgical treatment removes this sac/wall just like we would remove a cyst. Quilting or 3-point sutures are used to close and collapse the cavity and a good pressure dressing is applied to prevent recurrence.
Pain levels can vary significantly depending on: 1. size 2. location 3. depth 4. proximity to nerves or muscles Removal of a small, shallow lipoma on the back might cause negligible pain. Whereas, a large, deep lipoma over a mobile joint (shoulder) might produce more pain. On rare occasion, lipomas can even wrap deeper under muscle. Your plastic surgeon should be able to examine your lipoma and give you a better idea, although every patient has different pain thresholds. A small lipoma might only require a little Tylenol. A more complicated lipoma might necessitate stronger, prescription strength pain medicine, sometimes even a narcotic-based medicine. If you can immobilize your shoulder, it should help reduce pain and protect while healing, especially during the first couple of weeks. You could try an arm sling, a figure-of-eight brace, or even wrapping your upper arm against your chest/back (around and under the opposite armpit). Hopefully within a couple of weeks you will have significantly less discomfort. However, you will often have some "sensations" as some of the small nerves in the skin regenerate and heal...tiny nerves in the skin are alway cut when the skin is cut. You may experience occasional tingling, pin pricking, itching, aching, burning, etc...often normal sensations as a wound/scar heals.
The likelihood is very strong that all the nodules are lipomas or angiolipomas. Of course, the only way to be sure is to remove them and send them to the laboratory to be examined under the microscope. However, this is probably an unnecessary expense and suffering for something likely benign. Our most common course of action is to take out one or two that are the largest or most bothersome. When the results come back from the lab as a normal lipoma or angiolipoma, that usually gives the patient some reassurance that all of the other nodules are likely benign as well. Is is theoretically possible that one of them could be bad? Yes, it is possible, but very rare. Rather than removing the entire lesion, there are some less invasive or non-invasive options. An ultrasound is a relatively cost effective way to evaluate. An MRI would also be an option, but is typically much more costly. These modalities don't always give a definitive diagnosis, but the radiologist usually can tell benign from malignant lesions. Another alternative is to perform a punch biopsy without removing the entire nodule. The biopsy can be sent to the lab for analysis. In our practice, we typically remove lipomas and angiolipomas that are getting very large, uncomfortable, painful, or cosmetically offensive. Patients will often continue to observe small, less bothersome nodules, although those can certainly be removed as well. Removal is typically done under local anesthesia, although patients can be given IV sedation if they prefer. Hope this helps!
In addition to the very large size of your lipoma, the location over the shoulder joint will certainly add to the pain and discomfort you have after surgery. Since you are a dental assistant, you day is likely pretty active, and shoulder motion will continue to agitate the wound. However, if you can immobilize your shoulder a little bit, it should help reduce pain and protect while healing, especially during the first couple of weeks. You could try an arm sling, a figure-of-eight brace, or even wrapping your upper arm against your chest/back (around and under the opposite armpit). Hopefully within a couple of weeks you will have significantly less discomfort. However, you will often have some "sensations" as some of the small nerves in the skin regenerate and heal...tiny nerves in the skin are alway cut when the skin is cut. You may experience occasional tingling, pin pricking, itching, aching, burning, etc...often normal sensations as a wound/scar heals. If there is further concern, don't hesitate to go see your surgeon! Hope this helps!
