How Big Should the Lipoma Be for Surgery to Take Place?

Question

I have big one behind left elbow along with smaller one in same area that are starting to connect.  Also one in my upper left thigh size of green grape, and another one right thigh hard and pointy like a dart head, and one more on side of left side of stomach about big as a thumb.
None of it is painful unless I bump them accidentally or try to squeeze them.  They all seem to have many blood vessels visually seen in them.

Robert M. Lowen, MD · Answer

When patients present for lipoma removal in my practice, they usually pick the larger ones, the ones that bother them most cosmetically, or those that are causing some local pressure discomfort.The smaller ones are usually not treated unless they are closely accessible from the same incision that is being used to access the ones they want removed. The kind of lipomas described in this question could all be removed if they were bothering a patient.  For example, I recall a patient who just had one lipoma the size of a grape on the front of her thigh. It bothered her because she could always feel it or be reminded of it when she touched the front of her thigh.  Although it was not very big, she was very happy to see it gone. I use the Smartlipo Triplex 1440 nm laser to remove lipomas through a 3/8" incision.

Tanveer Janjua, MD · Answer

It is very important to understand that the diagnosis of lipoma should not be made by a patient without being examined by a physician. Many other lesions and even tumors can appear as bumps, nodules etc. You must have a physician determine the nature of the lump you have. Once it is established that you have lipomas then it is your choice whether to remove them or not. Lipomas by themselves are harmless unless they start causing symptoms like pain etc.
Regards.

Otto Joseph Placik, MD · Answer

In general. lipomas do not need to be removed if you know they are lipomas. The problem is we do not know if they are lipomas until we biopsy them, Rarely lipomas can be malignant (liposarcoma) but this is exceptionally rare.
In certain instances, lipomas may cause symtoms due to their growth. This can cause pain , discomfort, or obstructive problems.  They may need to be removed for these reasons.
In your instance, you may want to remove one or more to establish a definitive diagnosis.

Tom J. Pousti, MD · Answer

Lipomas are the most common benign tumor;  they are composed of adipose tissue. Sometimes these soft,  usually mobile  masses can grow in size and become an aesthetic or functional concern. Excision is best done when the lesions are smaller.

	Malignant transformation of lipomas into liposarcomas  it's extremely rare ( and controversial).

	Generally, I  recommend excision to allow for pathologic evaluation (which is the only  way to make a definitive diagnosis) and to  alleviate compressive symptoms it may be causing (as well as for cosmetic purposes).

	Best wishes.

Peter A. Aldea, MD · Answer

The word TUMOR means SWELLING in Greek.
A tissue swelling (tumor) can be BENIGN (OK) or MALIGNANT (cancerous). Although the appearance usually suggests the diagnosis, it can never 100% of the time accurately predict it. A history of fast growth, ulceration, irregular borders, bleeding, crusting etc, SUGGESTS (not predicts) that a swelling may be malignant. But the ONLY way to know what "it" is is to get a tissue sample out and have a PATHOLOGIST look at it under a microscope.
The odds are that you have a familial syndrome associated with fatty tumor growth. But, in very rare cases, these may mascarade as such and could be cancerous. The only way to know is to biopsy them EITHER by removal or by getting a liver of tissue out.
MEDICARE allows removal of tumors which block essential orifices (eyes, nose, ears, moth etc), which bleed and which have other aspects of cancers. In your case, I would suggest you consider removing the large ellbow one before it deforms the elbow further and see what it is.
Good Luck.

Richard P. Rand, MD, FACS (retired) · Answer

The smaller the lipoma, the easier it is to remove and with less scar. As Dr. Placik has pointed out, the problem without removing a lipoma is knowing whether it is a routine benign fat deposit or a rare cancer called a liposarcoma. That is also why liposuction of lipomas is not a good idea in my opinion because it destroys the ability to tell the difference between these two conditions.

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