Local vs general anesthesia for large lipoma?

Question

I have a large lipoma measuring approximately 8cm x 10cm on the right side of my trunk causing no pain. My PS will only remove it under general anaesthesia. I would really like to avoid this, and from what I’ve read, most lipomas can be removed under local. I understand that there is the possibility that the entire lipoma will not be able to be removed under local, but he still refuses to go that route. Should I get a second opinion or is this generally the case with a lipoma this large?

Raffy Karamanoukian, MD, FACS · Answer

Lipomas are benign fatty tumors that occur under the skin and less commonly within the muscle. They are associated with mild discomfort and a lump underneath the skin. It is always best to talk to an expert plastic surgeon to determine whether the lipoma is possibly a cyst or a tumor or hernia. We would have to remove the lipoma to be sure that it is not something else and we usually do this by sending it to a pathologist for evaluation. If a lipoma is painful, then an exam is needed to make sure it is not compressing on a nerve or whether the diagnosis is different. Aftercare for a lipoma includes gentle compression and Plato’s Scar Serum twice daily on the wound.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Ronald J. Edelson, MD · Answer

I have removed many lipomas that size under local anesthesia.  If the lactic surgeon is not comfortable doing it that way I’m sure you can find another surgeon willing to do it.

Darrick E. Antell, MD, FACS · Answer

There are many factors that go into a physician’s recommendation.  I would think that this could be removed with local and IV sedation rather than “general” anesthesia.  Without seeing and feeling the area I cannot state if I would feel comfortable using local only.  In the majority of cases I perform lipoma removal with local only.

Lawrence Kass, MD · Answer

Personally, if this was on me, I would prefer local anesthesia over general anesthesia.  I don't know why your plastic surgeon won't do this under local.  I have removed very large lipomas from all over the body under local anesthesia without a problem.  I think you should consider getting a second opinion.

J. Stewart Humphrey, MD · Answer

Small lipomas in favorable areas are often removed under straight local in the clinic. Moderate lipomas or those in more challenging locations are typicaly removed under IV sedation and local in the outpatient surgery center. Large lipomas are also sometimes removed under IV sedation and local, but as the size increases most surgeons are more likely to recommend general anesthesia. I personally would not want a 8 x 10 cm lipoma removed from my body under local anesthesia alone!

Marcus Davis, MBBS, MRM, FRCSEd (Plast) · Answer

Many thanks for your question.
In my practice I tend to remove most lipomas under Local anaesthesia, however if it is a very large lipoma that is sub-muscular (under the muscle) then I have a tendency to do these under General anaesthesia, purely because it is painful going through and under the muscle requiring an unsafe dose of local anaesthesia.
Perhaps a second opinion from a Board Certified Plastic Surgeon would be advisable. 
I wish you luck.
Marcus