Is Lipoma Removal Like Liposuction?

Question

My dad is going to have surgery to remove two lipomas from his flanks/lower back area.  I think a lipoma is some kind of fat deposit, so I'm wondering is lipoma removal anything like liposuction?  Is it a cosmetic procedure like liposuction, i.e. not covered by insurance?

Kevin Brenner, MD, FACS · Answer

Proper excision of a lipoma does neccesitate an incision in the skin. Very large lipomas will leave a large indentation in the surrounding tissue once the lipoma is removed. For this reason, it is important to have this done by a plastic surgeon who is familiar with and able to properly perform reconstruction of the deeper tissues. Although liposuction is possible for removing lipomas, it is only used in rare situations. Additionally, liposuction will not completely remove the lipoma and therefore will increase the chance of the lesion re-growing.

Larry S. Nichter, MD, MS, FACS · Answer

A Lipoma is simply a lump of fat, firmer in nature than the surrounding fat that acts like a benign tumor that keeps on growing even if you stay at the same weight. It is directly removed directly by surgery. Rarely for a huge lipoma, liposuction can be used but this increases the risk for recurrence as some lipoma cells remain.

	Here is an article you can read about using liposuction for Giant Lipomas that I wrote for Annals of plastic surgery    :Nichter LS, Gupta R*: Liposuction of Giant Lipoma. Annals of Plastic Surgery 1990; 24:362-365

Robert M. Lowen, MD · Answer

Using power-assisted liposuction I debulk them through a 3/8" incision and then remove them completely with scissors dissection, traction, and further dissection and extrusion. Most lipomas are very typical, both by appearance and history. If there is any concern that they are not benign, a biopsy or MRI can be done before proceeding, usually for lipomas over 5-6 cm, or any that  have had rapid growth.
  
I removed a 10 x 12 cm gradually enlarging lipoma on the right waist.  The access was through a 3/8" mm incision over the most prominent part of the lipoma.
  
The lipoma was outlined and anesthetized with tumescent local anesthesia. 
  
The lipoma is separated from the overlying skin with scissors dissection. A small liposuction cannula with power-assisted liposuction is used to soften and debulk the lipoma. Then the rest of the lipoma is completely and gradually removed using traction with clamps, dissection and extrusion. When removal is complete, the cavity is inspected with a fiberoptic headlight. A drain is placed for a week and the patient can return to non-strenuous activities and may shower any time.
  
For multiple lipomas of the chest or arms, a small stab incision is made with a #11blade. This 1/4-3/8" incision is usually enough to remove any lipomas up to about 3 cm by simple dissection and extrusion. I have done as many as 80 lipomas at a time with this method
  
The video shows how even a giant lipoma can be removed with a 1/2" incision.

David Hansen, MD · Answer

Lipomas are harmless and can be ugly bumps that are noticeable but the ugly scar from excision surgery can look worse.
Power assisted liposuction with a 2 mm canula can debulk the fat mass and  then a currette scraping of the pseud lining finishes off the job under local anesthesia with no scar at all for about $350 for a small lipoma.
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Gregory Turowski, MD, PhD, FACS · Answer

Liposuction is a surgical procedure to remove the unwanted deposits of fat from specific areas of body. Lipoma is a fatty growth under the skin layer, but needs to be excised by the surgeon and the specimen should be sent to pathology. Often, patients also ask if lipoma could be removed with the use of the laser, but that creates also the problem.
The laser technology will not allow a surgeon to have a tissue that need to be sent for the examination. The removal of lipoma is a medically necessary procedure and it is covered by the insurance. Liposuction is a cosmetic surgery, not covered as an elective procedure. Lipomas can be removed by liposuction but as stated above there is no pathology specimen and recurrence is higher. However, the scars are smaller.

Raffy Karamanoukian, MD, FACS · Answer

Lipomas are removed by surgical excision, not by liposuction. This should preferably be performed by a plastic surgeon to minimize scarring. In very specific circumstances where traditional surgery is contraindicated for various reasons, a patient may undergo lipoaspiration to improve symptoms associated with a lipoma.

	This procedure should also be performed by a plastic surgeon and a tissue diagnosis should be made prior to invasive lipoaspirative surgery to improve overall safety and maintain the highest standards of care.

Steven H. Williams, MD · Answer

You can remove lipomas with liposuction but it introduces two potential problems.
The first problem is being sure to have tissue for pathology.  While soft tissue masses that are otherwise asymptomatic can be a lipoma it can also be other things.  Pathologic diagnosis is important and liposuction alone can make getting tissue for pathology difficult.
The second problem is recurrence.  Lipomas can recur if not completely resected.  They tend to have defined borders and can be "shelled out".  Liposuction makes complete removal more difficult and may increase recurrence
I hope this helps

Sam Speron, MD, FACS · Answer

No. An incision is made to remove the lipoma in its entirety including the capsule.  
Liposuction is an option, but there  is no guarantee of removal of the entire lipoma, and this is not the preferred method of treatment.  
In the future, the injections that cause the fat to dissolve might be an option.  This is currently being investigated by the American Society of Plastic Surgeons in a study in the US.

Timothy G. Rodgers, MD, FAAD · Answer

Lipomas can usually be easily removed by making a small incision in the skin and "pushing" the lipoma out through the opening.  Liposuction is not he preferred method of treatment.