What is the best method for removing several lipomas?

Question

I have several lipomas, and I would number them in the hundreds (the biggest being roughly 2" long). My trunk and arms are the worst affected. I am not over weight and very fit so the lipomas look more obvious (hideous). What is the best method for removing several lipomas?

Raffy Karamanoukian, MD, FACS · Answer

The only way to effectively remove these lipomas is to stage surgical resection of them.  All other treatments are not time proven.

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

You most likely have the diagnosis of familial lipomatosis (other family members will have the same problem). Lipomatosis is believed to be a dominant trait in which multiple lipomas are present. Most are discrete, encapsulated lipomas on the trunk and extremitiesAlthough this condition is benign, many patients concerned with cosmesis seek removal of individual tumors. Treatment can include simple excision, endoscopic removal, or liposuction if large. Find the most qualified plastic surgeon to take care of this problem.

Lorrie Klein, MD · Answer

Board certified dermatologic surgeons usually have a lot of experience removing lipomas.  One of the tricks I use to completely remove them quickly, leaving only a small scar is to use a surgical tool called a "punch" which creates a small hole in the skin above the lipoma and then pull the lipoma through the hole.  Several can be done in under an hour.

Daniel Levy, MD · Answer

Dear Dune,
	I would first excise a few of the more noticeable ones and perform a pathologic exam to confirm they are lipomas. If they are ordinary lipomas then further excisions can be performed. If you have pathologic variants of lipomas (angiolipoma, angiomyolipoma, or even cysts) these may signal a genetic predisposition for underlying tumors and warrant further investigation of your general health.
	Multiple lipomas can be safely removed with standard excisional surgery under local anesthesia. In cases where a lipoma is on the upper trunk and greater than several inches, the Smartlipo (laser lipolysis) method is equally effective with less scarring.

Darrick E. Antell, MD, FACS · Answer

I have seen hundreds of patients for lipoma removal, and in most cases remove them with local anesthesia on the day I first see the patient. Usually the most visible or uncomfortable ones are removed at the first session.

	For most people we remove 2 or 3, but by prior arrangment, I have removed over 20 at one time.

	They are typically a benign growth, but we send the specimen(s) to pathology for evaluation.

Karthik Ram, MRCS, DNB · Answer

There is a unique technique by whic we can remove all the lipomas with minimal cuts. Hope this video will be helpful for persons suffering from this problem and for surgeons to understand this new procedure.Here, we infiltrate the tumescent fluid, followed by power assisted liposuction of the Lipoma. His helps in about 60% Lipoma volume reduction. The remnant Lipomas are squeezed removed through small nicks.

Jill Tomlinson, MBBS, FRACS · Answer

Great question!

	The majority of my patients with multiple lipomas opt to have them removed under a general anaesthetic through very small incisions. The patient and I select the ones to remove before the anaesthesia and mark each site with a marking pen. The incisions are closed with dissolving sutures and waterproof dressings are applied. All of the lipomas are sent to the lab to confirm the diagnosis.

	The most lipomas I have removed in a single setting under local anaesthetic was 26. The limiting factor in removing large numbers of lipomas is the amount of local anaesthetic that can be used in a single day, and the number of injections a patient is willing to have. I completely understand that most patients would prefer to be asleep than to experience 26 separate local anaesthetic injections!

	Depending on the number and size of the lipomas you may wish to have 10-20 of the most troublesome ones removed to begin with. Be aware that any surgical excision leaves a scar, but if your skin tends to form favourable scars and you have treatment with a skilled surgeon you will likely be very pleased with the results. Do discuss everything thoroughly with your doctor and be satisfied with the plan before electing to undergo multiple excisions.

	Good luck!

Pat Pazmino, MD, FACS · Answer

It is possible to remove many lipomas in the same setting. It sounds as if you have a great deal lipomas and are very experienced with this condition. Your best bet is to work with a board-certified plastic surgeon and determine how many you and your surgeon are willing to remove it once. In my experience, I have removed up to 30 lipomas in one setting. These were very small and superficial and were all that the patient and I were willing to perform as outpatient surgery.

Albert Dabbah, MD · Answer

Lipomas can occur in any individual regardless of weight. They can occur almost anywhere on the body as well. Removal of lipomas is perfomed by surgical excision. An incision is made over the lipoma and it is dissected from the surrounding tissue and removed. Multiple lipomas can be removed at the same time, depending on the number and size. If small enough they usually can be removed under local anesthesia, however larger lipomas may require other forms of anesthesia.

What is the best method for removing several lipomas?

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