Question for QtM et al Re: lipoma removal

[picunurse]

Since I can’t know everything, (sometimes anything :dubious: ) and my bookmarked med sites aren’t helping, I’m coming to the teeming millions.

Can large lipomas be removed my suction or do they require full exposure to be removed en masse?

[Qadgop_the_Mercotan]

From: Aesthetic Plastic Surgery Volume 26, Number 2 / March, 2002
The Use of Suction-Assisted Surgical Extraction of Moderate and Large Lipomas: Long-Term Follow-Up

http://www.springerlink.com/content/dbd0aw42rkremvfr/

Habib A. Al-basti1 and Hamdy A. El-Khatib1

(1) Doha, Qatar, QA

Abstract. Solitary lipomas and familial multiple lipomatosis are the most common benign tumors and are very well encapsulated. They are very slow growing and have the potential for recurrence if incompletely excised and a very remote chance for malignant changes. These can be freed from surrounding tissue without difficulty, but because of the fibrous nature of the capsule, its violation is more likely with suction technique and may result in an inadequate resection, possibly leading to recurrence. Furthermore, liposuction alone will not allow histopathological study of the swellings. Therefore, we report here the treatment of moderate (>4–10 cm) and large (>10 cm) lipomas with liposuction-assisted surgical extraction of the capsule via the same wound (1 cm in length). This capsule extraction is aimed at avoiding recurrence and evaluating the histopathological nature of these swellings. 16 patients (nine men and seven women) presented with solitary lipomas (in 11 patients) and multiple lipomas (in five patients) have been successfully treated.

Methods involved 1-cm incision for both liposuction and surgical removal of the capsule. Another 1-cm counter-incision may be needed in case of large size lipomas.

High patient satisfaction was achieved because of the good cosmetic results due to the small postoperative residual scar and the smooth postoperative course. There has been no recorded recurrence in six years postoperative followup.

So yes, it can be done, if the lipoma capsule is removed along with the contents via suction. Otherwise if the capsule is left behind there is increased chance for recurrence, and no opportunity to do definitive pathological studies to rule out those rare cases of malignancy.

[picunurse]

Thank you. The one in question is 20cm long and 8cm wide, just below the rib cage. It’s unknown how deep it goes, since they don’t show on ultrasound.

I guess the knife is the safest option.

[yoyodyne]

Geez, I’d think that was worth an MRI.

[Qadgop_the_Mercotan]

@picunurse

I guess the knife is the safest option.

Good question for your surgeon. I don’t do lipoma removals anymore, too messy and generally not necessary on my patients.

[picunurse]

@yoyodyne

Geez, I’d think that was worth an MRI.

MRI wouldn’t define it much better, since it looks the same as the surrounding tissue.

[irishgirl]

yoyodyne , assuming picunurse has no other complaints, lipomas are easy to diagnose, rarely malignant and generally don’t cause any issues. Removal is usually for cosmesis only. If picunurse’s lipoma is very deep, the surgeon will decide at the time of the operation whether or not to remove all of it, when he or she can visualise it clearly.

Irishfella and his sisters and mother have lots of them. SILs and MIL have both had several removed, irishfella’s don’t bother him enough (and I like playing with them, they’re kind of fun to poke).

Best of luck for the op** picunurse**!