Lipomas

Lipomas are benign and not dangerous to one’s health so in the majority of cases, an excision is not necessary. Lipomas can usually be diagnosed through a physical examination of the lesion, but if there is uncertainty over the diagnosis, an excision can be performed so that the tissue can be sent to a pathologist for confirmation. Other reasons why patients may choose to have a lipoma excised include continued growth, development of pain or discomfort, or location in areas that interfere with daily activities.

Lipomas can affect anyone, but tend to occur more frequently in adults between age 40–60. Some patients develop multiple lipomas over time, especially if there is a family history. Certain conditions such as familial multiple lipomatosis, Dercum’s disease, or Madelung disease are associated with multiple or atypical lipomas, but these are rare. Importantly, lipomas are not related to body weight. They arise from localized overgrowth of normal fat cells, not from overall fat accumulation.

Diagnosis is usually made through a simple physical examination. Lipomas have characteristic features:

• Soft, rubbery texture
• Easily moveable under the skin
• Slow, steady growth
• Typically non-tender

Most lipomas do not require imaging, but ultrasound or MRI is sometimes used for difficult to diagnose lesions, particularly when they feel deeper than normal.  In rare cases, a biopsy or excision may be performed if the diagnosis is unclear or if the lesion behaves atypically.

Lipoma excision is a straightforward, minimally invasive outpatient procedure that typically takes 30-45 minutes, depending on the size and number of lesions.

Excision Steps

1. Local anesthesia – The area is numbed thoroughly to ensure complete comfort. Patients typically feel only mild pressure, but no pain.
2. Small, precise incision – A small incision is made directly over the lipoma or within a natural skin fold to optimize cosmetic results.
3. Lipoma removal – The lipoma is gently separated from the surrounding tissue and ideally removed in one piece. This helps minimize recurrence.
4. Layered suturing – Dr. Eliades closes the incision with a deep layer of sutures that dissolves on its own, followed by a top layer that will be removed at a follow up visit.
5. Dressing and aftercare – A pressure dressing is applied temporarily to reduce the risk of bleeding or fluid collection. Detailed aftercare instructions are provided.

Recovery & Aftercare

After excision, patients may experience mild soreness, swelling, or bruising, which typically resolves within a few days.

Standard aftercare includes:

• Keeping the incision clean and dry for the first 48 hours
• Avoiding submersion (pools, baths, ocean) for 2 weeks
• Daily wound care as instructed
• Avoiding strenuous activities
• Returning for suture removal (usually 14 days)

The incision will continue to heal and fade over several months.

Complete excision dramatically reduces the chance of recurrence to less than 5%, however, if the lipoma is not fully removed, recurrence is more common. Because lipomas are fatty overgrowths within other subcutaneous fat they can sometimes be difficult to discern from normal surrounding fat. For these lipomas that are not well-encapsulated, the recurrence rates can be higher. It is also important to distinguish between recurrence of the original lipoma and the appearance of a new, separate lipoma in the same or a different area, which can happen, especially in people with genetic predispositions like familial multiple lipomatosis.