Antibiotics Necessary Before or After Lipoma Excision?

Yes, it is a must.
Any invasive procedure where skin is excised should be preceded by an antibiotic. Even if you are allergic to a lot of them, your surgeon should be able to find one that can be used. It does not have to be for many days. At the minimum one single dose of intravenous antibiotic given before starting the surgery is a must.
Regards

Lipoma removal is done in a sterile surgical fashion.  Healthy patients are at low risk of infection. However, antibiotics are prescribed on a case by case basis to minimize infection.

As a general rule, I do not prescribe antibiotics either before, or after lipoma removal.  In my practice the procedure is performed in an on-site accredited OR where the conditions are clean and the procedure is performed in a sterile manner.

 

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

Great question Tark! I do not routinely use antibiotics before or after lipoma excision. This surgery carries a very low risk of infection and antibiotic use can have problems - such as allergy and (on a population level) the development of "superbugs" that are resistant to antibiotics.

but this all depends on your current health and medical problems.  some patients may need to be covered with an antibiotic but these would be the exception to the rule. 

most lipoma removal procedures require nothing more than a clean field and adequate post-operative care.

Hello,

Antibiotics in your case would likely be a bad idea. They can be given prophylactically but the practice is a matter of opinion.

 

Best Regards,

 

John Di Saia MD

That's a great questions!  And as you can see from all of our answers, the use of antibiotics before clean surgery can vary among different physicians.  

Antibiotics are use for two main reasons, to treat a current infections (therapeutic antibiotic use) and to minimize the risk of infection during surgery (prophylactic antibiotic use).  In general, antibiotics are not necessary during clean surgery such as lipoma excisions in healthy individuals.

In the past, we use to routinely put patients on antibiotics prior to surgery.  Many studies have found that prophylactic antibiotics before clean surgery on the skin is not necessary and does not reduce infection rates. In fact, when we put everyone on antibiotics before every surgery, we are more likely to have complications like antibiotic resistance, diarrhea, and allergies (such as in your case).

Several guidelines have been published in the literature about this issue.  As long as the surgery site is not infected beforehand, there is really no need to give antibiotics for skin surgery in healthy patients.   The overall rate of wound infection on skin surgery is less than 1%.

There are several times when I may consider antibiotics:  

1.  If surgery is done in certain areas: infected surgical site, lower legs, groin, lips, and ear-- because studies have shown these sites are more likely to get infected.  I may also consider it if the surgery was very complicated.

2.  If a patient has a prosthetic heart valve, heart transplant or congenital heart issues-- because if your wound were to get infected, it may spread to involve the heart valve.

3.  If a patient had a recent joint replacement-- because if your wound were to get infected, it may spread to involve the prosthetic joint.

With that said, everyone is different and these are not hard and fast rules.  I would trust your surgeon to help you make the best decision in your case.

Best,

Dr. Mann