Feasibility of Removing Unencapsulated Lipomas Via Liposuction?

I would concur with many of my colleagues that it is a bad idea to remove lipomas with liposuction.
Lipomas are abnormal growths of cells. Although the vast majority of them are non cancerous, lipomas can be invasive. Removal of them is usually straightforward for a board certified plastic surgeon, even if they are under muscles, nerves, or next to bone where specialized training is required for their removal.
Recurrent lipomas are much harder to remove and more dangerous because of scar tissue that obscures borders, hides nerves and masks recurrences that can be very difficult to remove completely without some disfigurement that always occurs when you don't know where the remnants of this benign tumor are sitting.
Don't take the cheap way out.

Unencapsulated Lipomas can be reduced by liposuction and may be a valuable treatment option for Madelung's disease - also called Benign symmetrical lipomatosis if in areas where critical anatomical structures such as nerves or major blood vessels live (for instance the back of the neck and upper back might be areas where this could be used.) Benign symmetrical lipomatosis disorder is characterized by  multiple, symmetric, nonencapsulated fat masses in the face, neck, and other areas. Typically, this entity has been related to the presence of three anterior bulges in the neck. I was the first to describe this technique on a giant lipoma of the back (see Nichter, LS:  Annals of Plastic Surgery  1990 Apr;24(4):362-5. Liposuction of giant lipoma). I do agree however with other authors that recurrence of this problem is increased with liposuction but none-the-less may be a valuable method of treatment for patients with particularly large lipomas in anatomically favorable locations, especially unencapsulated lipomas.

Here is some background information on your particular problem: Benign symmetric lipomatosis, also called Madelung's disease usually occurs in adults from ages 30 to 60 years old. It is somewhat rare with an incidence of about 1 in 25,000. It is 15- 30 times more likely to occur in males and thought to be non inherited..  More than 90% of the patients have associated alcoholism and stopping alcohol ingestion can stop the progression of this process in many patients. Resection is the most common approach to management but may not be currative, which is why liposuction may be considered as a management tool in areas that do not have structures that can be readily damaged by this technique. Mesothrerapy has also been described as a non-invasive technique but should be considered experimental at this time.

 

I totally disagree with the recommendations of removing ANY type of lipomas via any type of liposuction. This is because the recurrence rate is so high. The reason is the capsule (live cells of the lipoma) remain to re grow. The only acceptable method that will be insurance covered is excisional removal. Regards.