Lipoma excision is the surgical removal of lipomas present in the body of persons affected by lipomatosis. People affected with lipomatosis have fatty lump-like accumulations in the subcutaneous tissues of the head, neck, shoulders and back. These fatty deposits are slow-growing benign tumours that are mostly painless and soft, mobile masses. A lipoma or multiple lipomas that exceed 5 cm in size and cause cosmetic disfigurement, pain or restrict movement in individuals, require surgical intervention. The classic method for removal of lipomas is excision biopsy or lipoma excision, which involves the incision and removal of the deposits and their capsules. However, the surgical removal of a large lipoma or multiple lipomas often results in disfiguring scars.
Outlining the lipoma area prior to the surgery with a marker serves as a guideline for the surgeon. The marked area is then cleansed with betadine solution. Sterile towels are used to drape the area after cleansing. Local anaesthesia is administered along with a field block into the subcutaneous area.
This procedure is followed for lipomas of smaller sizes. An incision of 3-4mm is made over the lipoma, following which a curette is placed in the wound to cut away the lipoma from the surrounding tissue. The tumour is then enucleated through the incision with the curette. A pressure dressing is applied to prevent the formation of hematoma after enucleation. Sutures are not required for this procedure.
Larger lipomas or multiple lipomas spanning larger areas are best removed by incisions made on the skin overlying the lipoma. The incisions are made in the form of a fusiform excision that are aligned with the skin tension lines and are smaller than the underlying tumour. A haemostat is used to grasp the skin inside the incision; this provides the necessary traction for removing the tumour. Once the central island of skin has been grasped by the haemostat, dissection is performed beneath the subcutaneous fat to the tumour. A scalpel is used to cut away tissue around the lipoma. Cutting of tissue is carefully performed under direct supervision to avoid damage to surrounding nerves or blood vessels. For further removal of the remaining lipoma mass, haemostats or clamps are used. Once freed, the lipoma is removed as a whole, and haemostasis is achieved.
Occasionally drains have to be placed for preventing fluid accumulation. The skin is then closed with nylon sutures and a pressure dressing is placed to prevent formation of hematoma. The wound is checked in 2-7 days and the sutures are removed after 21 days. Lipoma excision often results in complete cure. Common risks associated with lipoma excision are hematoma formation, surgical infection, injury to nearby tissues, and deformity due to the incision.