Lipoma is defined as a benign growth of cells of the adipose tissue that can appear in any location of the human body, although is formed more frequently in the subcutaneous layer of the dermis. Lipomatosis is the grouping of fatty deposits in various body regions and it is accompanied by a hereditary component.
Do Lipomas Need To be Removed?
It usually grows slowly and feels like a painless mass, circumscribed and mobile under the skin. Lipomas can also be associated with other syndromes and have a more aggressive or malignant character and so they need to be removed.
Lipomas can be classified into different morphological features such as lipoma, angiolipoma, well-differentiated lipoma, and liposarcoma.
There are different classifications depending on its location, depth; for example simple lipomas, fibrolipomas, angiolipomas, fusiform cell lipomas, myelolipomas and pleomorphic lipoma.
For ambulatory surgical removal of a lipoma, the following indications must be met: pain, rapid growth, change of appearance, aesthetic alteration, suspicion of malignancy, patient’s concern in the absence of its etiology. On the other hand, it is a contraindication to the surgical extraction of a large lipoma or of compromised localization, since for safety in these cases it is recommended to address them under general anesthesia and monitoring. Lipoma infection can be a relative contraindication, however, it is advisable to wait for the performance of an antibiotic prior to the surgical option, in order to better define its dimensions and thus prevent recurrence.
The most common complications are a seroma, hematoma, dehiscence of the edges, infection, hypertrophic scar, pigmentary alterations in the area, keloids, relapse, etc. In cases of diagnostic doubt with another possible pathology, a differential diagnosis will be carried out by a biopsy to confirm the diagnosis. The biopsy is performed by taking a sample by puncture-aspiration with a thick or thin needle, or by extirpating the lesion by excision surgical procedure, with previous local anesthesia and sending to the laboratory for histological study. Due to the clinical manifestations, to the location of the tumor with respect to the well delimited surrounding tissues and meticulous palpation, it is not usually necessary to apply imaging tests to complete the diagnosis.
How is The Procedure Performed to Remove Lipomas?
In the minor surgery room of the health center, with asepsis according to protocol, the skin is washed and disinfected.
The patient must be in the supine position and before preparing a sterile field with a fenestrated cloth, the mass is palpated and the lesion is marked with a dermographic pencil, then a solution of povidone-iodine 10% with wide margins.
Doctors proceed to local anesthesia with two punctures at both ends of the lipoma, with the help of a change of plane to cover the whole area surrounding the mass. Once the area is anesthetized with 2% mepivacaine, the procedure has performed an incision on the fatty mass, deepening to the subcutaneous tissue.
Expose the fatty tissue to be removed, the tissues with the help of the scalpel handle, using its proximal part (blunt dissection), delimiting all the contour of the dough separating the fibrous capsule of the other tissues, without injuring other tissues and avoiding sectioning blood vessels that may cause bruising, difficulty of visualization during the intervention or postsurgical complications. Next, the lipoma is clamped and is pulled, exerting subjection of the perilesional skin to favor extraction. This maneuver will be repeated as many times as necessary until making sure to remove all the remains of fatty tissue.
Regarding the postoperative period, it is prescribed oral treatment and local cold on the dressing (it makes it difficult to get wet or take off). The first review is at 72 hours later, where a local antiseptic is applied and it becomes to cover with an adhesive non-stick dressing.
The patient will continue to apply a local antiseptic daily at home until the review on the tenth day for the withdrawal of the approach points once solved cutaneous integrity.
A lipoma is a collection of well-defined fat in a body region and will depend on its location to be causing discomfort, irritation, pain and may even produce alterations that involve an aesthetic or mechanical problem. As with any other surgical procedure, doctors choose to intervene with a patient with this condition only if they comply with the aforementioned criteria.
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