Quite sure I have lipomas along my rib cage. the fat deposits move arond under my forefinger and are quite soft/forgiving to the touch. the lipoma removal research i have done show many approaches to getting rid of the lipoma deposits. what have others tried and are they happy with the results?
How Do You Get Rid of Lipoma Deposits - What Technique?
Doctor Answers 13
Lipomas are formally excised with plastic surgical closure. Subcutaneous lipomata are simple to remove in the office under local anesthesia. For more diffuse tumors or submuscular lipomata, excision is more complex. Lipomata of over 5 sq cm are at risk for malignant degeneration. Also, keep in mind that the larger the tumor grows, the longer the scar. I treat many patients with lipomatosis, requiring multiple surgeries, and like to operate when they are small and the procedure is the least invasive possible.
I am frequently asked whether large lipomas can be removed via liposuction. The answer is yes, but this is not covered by insurance based on data which suggest that the removal is incomplete and the tumor will regrow. All tumor removed should be evaluated by a pathologist to rule out other etiology or malignancy.
Best Way to Remove Lipomas
Lipomas are benign (meaning non-cancerous) fatty tumors that grow under the surface of the skin. Usually, lipomas are surgically removed with either local anesthesia (for small tumors) or general anesthesia (for larger tumors or for patients who are too anxious to undergo removal under local). Usually the incision is smaller than the actual lipoma, but it has to be long enough to actually get the tissue out. Overall, excision is an easy way to remove these lesions, and most patients are happy with the result since an incision is usually less conspicuous than a mass.
Most of the time, lipomas look distinct enough that it isn't necessary to send them for pathology. If it's going to be sent for pathology, however, it's best to remove it in one piece, which may require a longer incision (sometimes nearly as long as the lipoma is across).
Liposuction can be used, which has the advantage of a much smaller incision, but it isn't possible to send the tissue for pathology, and it won't reduce the incision length much for lipomas that are smaller than about an inch or so.
Small Punch Removal (Piezosurgery) Works Well for Removing Lipomas and Sebaceous Cysts
Surgical excision covering the entire diameter of a lipoma (a benign fat tumor) or a sebaceous cyst (an overstuffed pore comprisedof a sac wall and containing thick oil gland secretion and cellular debris) is the traditional method for removing both these kinds of growths. Since lipomas and cysts can sometimes reach several inches in diameter, the resulting scar following healing can be quite prominent and esthetically displeasing.
Piezosurgery, on the other hand, has the advantage leaving a much smaller wound and hence a much smaller mark following complete healing. In this method, a small punch hole measuring only about 3- 6mm (between and eighth to a quarter of an inch) depending upon the size of the growth is made, under local anesthesia, in the very center of the growth. The fatty contents of the lipoma or the excess fatty tissue of the lipoma are then squeezed and milked out through the small opening, which can then often be closed with one to three stitches depending upon the length. Naturally, healing is faster for this kind of small wound and the resulting mark barely perceptible in most cases following complete healing.
Mesotherapy is a wholly nonsurgical approach to treating lipomas by injecting fat dissolving agents directly into them. Currently no commercial product is available for this purpose in the U.S., although two companies are close to completing their clinical trials and seeking FDA approval. In the meantime many physicians are having injectable preparations compounded for use in this fashion, and this remains an alternative to any form of surgical intervention for lipomas.
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My technique for removing lipomas
I use SmartLipo Triplex to help dissolve them via a 5 mm incision. Most lipomas are very typical, both by appearance and history. If there is any concern that they are not benign, a core biopsy can be taken before proceeding.
I recently removed a 5 x 5 cm gradually enlarging lipoma on the right upper back. The access was through a 5 mm incision in the posterior crease of the armpit.
The lipomas was outlined and anesthetized with tumescent local anesthesia.
The lipoma can be very fibrous. The laser progressively breaks down all the fibrous tissue and melts the fat. The endpoint is a very smooth surface within the marked boundaries of the lipoma, and no lumps on palpation, indicating that no further laser is needed. Using a small liposuction cannula to remove any tissue remnants, the area of the lipoma is gently aspirated. Care is taken not to overdo it and get a depression. The use of a small clamp with jaws that open and close only at the end is very helpful for removing small remnants. The incision is closed with a single stitch and a circumferential wrap is done over a piece of topifoam to minimize bruising.
For multiple lipomas of the chest or arms, one spot is chosen that is strategically located to treat surrounding lipomas. I try to camouflage that point in a flexion crease, for example at the elbow crease, back or front. The incision is only 5 mm.
Larger lipomas are a little easier to remove as they don't slide around so much. If there is a small palpable remnant that can't be pinned down, it is immobilized by a pinch and removed with a long, thin alligator jaw forceps. The remnant is grasped and with gentle twisting, it comes free and can be withdrawn.
Particularly with the larger lipomas, patients must accept that there is a risk of recurrence. Since the recurrence is usually very slow, up to five years or more, the trade-off is acceptable. The minimal scarring and inconvenience of a small procedure is worth it if another removal is needed years later.
Removal of small lipomas is usually straightforward
Small lipomas that are easily mobile can be removed under local anesthesia. Frequently the incision used can be smaller than the lipoma. I generally repair the incision with internal stitches, so that no external stitches are required. Many insurance companies will cover the cost of lipoma removal, particularly if the lipoma is enlarging or uncomfortable.
Basic surgical principle is biopsy all new growths to have a confirmed histological diagnosis whether they cliniclly appear benign or not. . A surprise can be sometimes fatal. On that basis you should have some of these tumors surgiclly biopsied. Once it has been determined that they are benign they can be wtched if you do not go through the aggrevation of surgical excisions and the cost.. On occasion multiple neuro fibromas may look like lipoma.
Most lipomas can be removed very easily under local anesthetic in the office. My technique is to use a small hole through the skin to remove even very large lipomas in order to minimize scarring, downtime, and pain. A small "punch excision" is made through the skin after numbing the entire lipoma and surrounding skin and undermining and pressure is used to "extract" the lipoma. Quick and easy and painless. I will do liposuction only on very large lipomas (Grapefruit size)
Lipoma removal options
Surgical option is preferable in most cases as lipoma surgery may be medically indicated if the subcutaneous nodule is symptomatic or suspicious because of possible change in size. For larger lipoma on the back, tumescent liposuction may be a better option to minimize scarring involved with surgical excision.
Surgical excision is best lipoma treatment for a number of reasons
Removal of a fatty mass is performed first and foremost to establish that a Lipoma is all that the mass represents. There are other more rare and dangerous tumors that can look like Lipomas from the surface of the skin and the only way to tell requires removing them. Most are sent for pathological evaluation.
Sometimes a tumor looks grossly (when they are removed,) so much like a Lipoma that pathology can be waived. I sometimes leave this up to the patient. Liposuction destroys the tissue and it cannot be evaluated by pathology. This removes the option of knowing what the lump really is for certain.
The key on these things is to get them removed while they are small, so they do not leave a "dent" and the pocket created in removing them is small. Patients tend to be happy after having these lumps removed for the piece of mind (knowing what they are and that they are gone) not to mention the improved appearance.
Lipomas are best removed surgically
Lipomas are best removed using an incision over the tumor, or perhaps a short distance away in a more hidden area, if possible.
Liposuction has been used in the past, especially for those on the forehead or face, and I have used an endoscope to remove one on the face through a hairline incision.
Using liposuction or lipodissolve will not get all of the tumor, and even though most are benign, and the lump could still remain. Absorption of fat damaged by lipodissolve or another form of injection would be unpredictable and I cannot recommend this procedure.
The problem with non-surgical removal (including liposuction) is that tissue will be left behind, causing possible cosmetic effects and possible regrowth. in the rare case of liposarcoma (a malignant lipoma) the non-sirgical techniques could significantly complicate the problem.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.