Feasibility of Removing Unencapsulated Lipomas Via Liposuction?

Question

I was diagnosed with either type 2 madelung's (gp) or lipoedema (specialist in CA) (got a biopsy done and lumpy nodular fat). It was recommended that I seek liposuction for the affected areas. The specialist in CA seemed to recommend bodyjet due to some studies out of Germany. My gp indicated he thought local only true tumescent was the way to go. I would like advice on seeking a doctor who will treat the condition and what method would be ideal.

Brent Moelleken, MD · Answer

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.

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

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.

Ricardo A. Meade, MD · Answer

Your lipomas will continue to recurr. The technique of removal should not be determined by a family practitioner. No trendy technique in liposuction has proven to be superior in this circumstance so don't be fooled. Regardless of the technique, your result should be very reasonable so select your plastic surgeon by first ensuring that he's board certified by ABPS.
Best Wishes,
DoctorMeade

Otto Joseph Placik, MD · Answer

I, in agreement with the other surgeons below, do not necessarily feel that waterjet offers superior results when compared to other techniques for fat extraction.
the advantage to liposuction  removal of lipomas are the limited scars. The disavantage is the likelihood and inevitablity of incomplete removal. When removing tumors, benign or maligant, we generally prefer to excise a tumor for defnitive treatment. When our goal is not necessarily curative, we sometimes perform a debulking procedure. Tumor is left behind and has the potential to grow back (recur).
Using liposuction is more of a debulking procedure rather than a curative procedure.

Farbod Esmailian, MD · Answer

Not the best way to go about removal of lipomas.  As long as you are willing to accept a high recurrence rate then go for it.  Otherwise the best method to decrease your recurrence rate would be to remove it via excision.
Good luck.

Michael A. Jazayeri, MD · Answer

This is a tough situation!
The gold standard for removing a lipoma is excision. This will result in the lowest recurrent rate. For insurance purposes, the lipomas must be sent to pathology for re-reimbursement.
However, if you have multiple lipomas covering a large area, are you willing to have multiple scars or one long scar to remove all of them?
In certain situations, liposuction may be used, realizing the lipoma may not be removed adequately and the risk of recurrence is higher. Also, some lipomas are encapsulated and are not amenable to liposuction and have to be excised regardless.  This, therefore, will be a balancing act.
I recommend consultation with a board certified plastic surgeon. You may want to get a second opinion as well and "put every thing together".

Darryl J. Blinski, MD · Answer

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.

John P. Stratis, MD · Answer

First of all it has been my experience that insurance companies almost never pay for liposuction removal of lipomas. As soon as they see the word "liposuction" they deny.
Second, I have personally used probably every means of lposuction, traditional, tumescent, Vaser, all the lasers and the body jet and can safely say that the most important component is the person who is doing the procedure. The differences of the technique used are minor when compared to the experience of the person using the tool.

Steven Wallach, MD · Answer

First, body jet is just one form of liposuction. Second, liposuction in general ins not the best way to treat lipomas. They often do not remove them completely. They are usually best removed by simple surgical excision.

Samir Shureih, MD · Answer

MSL, Multiple Symmetrical Lipomatosis, also known as Benign Symmetric Lipomatosis or Madelung's Disease and Lanois-Bensaude Syndrome is a metabolic condition characterized by the growth of fatty masses around the face, back of the head, neck, upper arms, abdomen, back and upper leg in a very specific pattern or distribution. Unlike the usual lipoma, these benign, fatty masses are not enclosed within a membranous capsule with very distinct boundaries. It is because of this characteristic, as well as the absolute symmetry in their occurrence that the condition is often dismissed as simple obesity
The instrument used is a help the person behind the the instrument is who is important.
Waterjet Liposuction has just come from jermany with very little scientific literature behind it to say it is better than suction assisted liposuction or Ultrasound Liposuction
All liposuction these days is done with the tumescent technique.
It does not make a bit of difference what method is used.
Choose a BOARD CERTIFIED PS. Experience counts.
Depending on the size, Liposuction will be effective.

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