What is the role of surgery in the treatment of lipomas?

Updated: Mar 26, 2020
  • Author: Todd A Nickloes, DO, FACOS; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Answer

Complete surgical excision with the capsule is advocated to prevent local recurrence, whether the lipoma in question is subcutaneous or intracardiac in origin. These lesions may be lobulated, and it is essential that all lobules be removed.

Specific therapy depends on the location of the tumor. [23]

Subcutaneous lipomas are removed for cosmetic reasons, and hence, a cosmetically pleasing incision should be used. [24] The incision is usually placed directly over the mass and is oriented to lie in a line of skin tension.

Liposuction is an alternative that allows removal of the lipoma through a very small incision, the location of which may be remote from the actual tumor. [25, 26, 27, 28] The lesion may also be approached by means of advanced minimal-access tissue dissection methods, with the use of a dissecting balloon. [29] These latter two methods allow the incision to be placed in an inconspicuous location. For example, axillary incisions may be used to remove lipomas from the back.

Liposuction may be employed more often in small facial lipomas, because favorable aesthetic results have been obtained through strategically placed incisions. Liposuction is indicated for the treatment of medium-sized (4-10 cm) and large (>10 cm) lipomas; in small lipomas, no advantage has been reported, because these tumors can be extracted through small incisions. [25, 26, 27, 28]

Lipoma formation has been reported as an unusual complication of liposuction and has also been found to occur following trauma. [9, 30] The mechanism in these cases is unknown. Research on genetic markers of atypical lipomatous tumors and liposarcomas is ongoing. These tumors have been shown to express receptors for leptin. [31]


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