Lipomas are benign fatty tumors that may be removed for symptomatic or cosmetic reasons. Common removal techniques are limited by the risk of scarring and recurrence. The following paper provides a review of lipoma excision techniques and possible alternative technologies that have been tested or are being developed. Of the reviewed methods, liposuction is the most effective overall in removing adipose tissue, but is hindered by associated costs. Deeper lipomas may be ablated with laser technologies, although larger incisions are required. Additionally, study results of ultrasound and pharmaceutical methods are promising, but require FDA approval before becoming a prevalent practice.
Lipomas are benign tumors composed of subcutaneous adipose tissue. They are typically asymptomatic, but may cause discomfort with direct pressure. Removal is typically done for symptomatic or aesthetic purposes. The rare variant of liposarcoma requires aggressive surgical removal and close monitoring for recurrence. Lipomas are typically removed by excision, with potential complications of bleeding, infection, seroma, scarring and recurrence. The following review focuses on the current methods of lipoma excision, as well as alternative removal methods, including cauterization, liposuction, and laser removal. Experimental techniques, such as ultrasound, micro wave, and pharmaceutical treatments, are also reviewed.
The following methods and techniques are generally implemented for lipoma extraction.
The borders of the lipoma are marked with a surgical pen, using palpation to detect the edges. The skin is cleansed with chlorhexidine or alternative disinfectant and a ring block is performed using lidocaine with or without epinephrine. The patient is draped to maintain a sterile operating field.
Incision and pressure method
The surgeon performs a linear incision about 1/3 to 1/2 the diameter of the lipoma, on the skin directly above the lipoma. Usually Metzenbaum scissors are inserted and spread circumferentially around the tumor in order to break up fibrous bands connecting the fat lobules to the surrounding tissue. Once separated, the lipoma is then expressed applying digital pressure to the edges of the mass.
If necessary, a hemostat may be used to provide traction and the incision may be extended to facilitate removal. The resultant cavity is explored to ensure adequate hemostasis and complete removal of fatty tissue. This method of extraction is most effective for encapsulated lipomas but is commonly employed in the removal of non-encapsulated lipomas as well.
Punch (enucleation) technique
This method utilizes a 4–6 mm punch biopsy tool, 3 mm curette, tissue scissors, and a hemostat. After pre-operative preparations are completed, the surgeon stretches the skin over the lipoma perpendicular to skin lines. Once taut, the punch tool is centered over the lipoma and is applied with downward pressure and rotation of the tool, removing the epidermis and dermis.
A curette is inserted through the incision and the surrounding tissue is scraped with the curette. Once freed, the lipoma is extracted through the incision using a hemostat. Repeated curetting may be necessary in order to deliver portions of the lipoma through the opening. In larger lipomas, multiple small incisions or punches may be necessary for segmental extraction.
Elliptical excision method
For large or complicated lipomas, elliptical excision may be necessary. This involves removing a football-shaped wedge of skin in order to maximize visualization of the surgical field. Once exposed, the lipoma is dissected away from the surrounding tissue and removed as a single mass or in segments.
While this method results in larger scars than previously described methods, elliptical excision may improve cosmesis by removing excess stretched tissue that arises from slow expansion of the fatty tumor. The removed fat may or may not be sent for histopathologic analysis. Potential complications include bleeding, infection, seroma, scarring, pain and recurrence .
The Average Cost Of Lipoma Removal
The cost of surgery for the removal of a Lipoma is typically ranges from INR 10,000/- to 25,000/- depending on the case. Please be aware lab and consultation are charged separately, but sometimes Lipomas do not need to be sent to the lab. Lipomas on back, front and shoulders particularly larger Lipomas can be more expensive as they can be considerably more difficult to remove.