I assume you mean that you have a l lipoma overlying your rib, not in, between or under your rib. That said, you have a movable, soft subcutaneous mass that is uncomfortable.My general approach to lipomas on the trunk is to anesthetize the skin around them and then infiltrate some tumescent fluid anesthetic around them, that acts as a heat sink for the heat generated by the laser. I then make a small incision, about 3/8", and soften and melt the lipoma with the Cynosure Smartlipo Triplex 1440 nm wavelength laser. The laser is computer controlled and the cut-off temperature is set to turn the laser off if exceeds 48 degrees C.After feeling the lipoma soften and disappear to touch and observation, I insert a small alligator clamp to manipulate and feel any remaining fibrous remnants, which I extract. I continue until I am as sure as I can be that no lipoma remains. In larger lipomas I may also use a fine liposuction cannula to evacuate any remnants that I cannot feel or palpate with the alligator clamp.Usually no drains are used, but for a larger lipoma, like some on the back, I will put in a seroma cath until the first post-op visit. Incisions are closed with one or two stitches.If multiple lipomas are close to each other, I will remove all of them through the same small incision.Since this technology is not used by many doctors, your surgeon may make an incision over the lipoma of the length felt necessary and remove it by direct dissection.With any lipoma removal, the patient needs to be informed, that there is a small chance of recurrence.Giant lipomas, 10 cm or more, should be biopsied and the diagnosis established that they are benign before proceeding with removal.
