Large Lipoma Removal - Surgery or Liposuction?

Question

I have a large (abt the size of a small lime) lipoma on my upper thigh. I just saw a general surgeon who said it could be removed via surgery (with a drain, leaving an indentation & scar, with a recovery period >= 1 week, covered by insurance) or via liposuction (no drain, no indentation, minimal scar, & not covered by insurance, abt $2500), with about the same long-term risk of it recurring. I don't care too much about the scar, but the indentation worries me. Any thoughts on which way to go?

Robert M. Lowen, MD · Answer

My approach to removing a lipoma the size of a lime, about 5-6 cm in diameter, would be power-assisted liposuction debulking and complete dissection and removal through a 3/8" incision.
While lipomas are commonly removed with surgery, involving a long incision and direct dissection around and under the lipoma, I have been removing lipomas up to 12 cm in diameter through a 1/2" incision. Complete removal is confirmed by inspection with magnification and fiberoptic illumination after meticulous surgical dissection, traction, and extrusion until removal is complete.
For a lipoma the size of 5 cm or more, I would insert a seroma catheter drain to collapse the cavity and get the surfaces to adhere without fluid accumulation. The drain would remain for 5-7 days.
With liposuction alone, it is not possible to know that all the lipoma has been removed and there is a large risk of recurrence. Most surgeons use a long incision for access. By debulking the lipoma with liposuction and then completely removing it and confirming it under direct vision, the risk of recurrence is minimal.
I use the code for excision of a subcutaneous lesion, and insurance has been covering some portion of the cost for patients if they have met their deductible. It is the same thing as removing a subcutaneous lesion, but less traumatic and with minimal scarring.

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

Michael A. Zadeh, MD, FACS · Answer

Hello Jeri,

	Liposuction is not as effective as surgical removal for Lipomas. The risk of incomplete removal and recurrence is much higher. The indentation is due to the large space that is left after removal of the lipoma. This indentation often resolves with time as your body's tissues grow into the cavity. I have removed many lipomas without drains and with excellent results without indentation. Good luck to you!

Large Lipoma Removal - Surgery or Liposuction?

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