A lipoma is a noncancerous or benign lump of fatty tissue that is usually found below the skin (subcutaneous) and slowly grows over months or years. Lipoma is a frequently occurring condition, affecting 1 in every 1,000 people. These growths are found slightly more often in men than in women and lipomas are the most common soft tissue lump found in adults. People who have a Lipoma will usually only have one, however, about 20% of affected people can have multiple lipomas. They can be found in all age groups, and may even be present at birth, but lipomas are most prevalent in people aged 40 to 60 years old.
What are the Symptoms of Lipoma?
- Present below the skin
- Usually there is no change to the overlying skin (like drainage or redness)
- Usually are located between the skin and fascia of the muscle, but may be located below the muscle fascia, within the muscle itself
- Can occur anywhere on the body, but are usually seen on the neck, back, abdomen, shoulders, arms and thighs
- Less often form within muscles or internal organs
- Soft and usually painless to touch unless they cause pressure on surrounding tissue
- Most are easy to move with slight finger pressure (mobile or partially mobile)
- Small in size; typically less than 2 inches in diameter but can reach up to 8 inches or even larger
- Not usually painful, but if they press on nearby nerves or if they have many blood vessels, they may be sensitive
What are the causes of lipoma?
Lipomas occur due to an overgrowth of fat cells that can be due to a faulty inherited gene. They can also form due to an injury (localized trauma) or as related to a specific medical condition like Gardner’s syndrome. In some instances, doctors still do not fully understand the cause.
How is lipoma diagnosed?
In most cases, surgeons can diagnose a lipoma with a simple physical examination. Lipoma usually feels smooth, soft, spongy, movable, and painless. However, if the lipoma is big in size and painful, your doctor may advise a lab test to confirm that the growth is not cancerous. These investigations may include a biopsy, ultrasound, CT scan (computed tomography), or MRI (magnetic resonance imaging).
Once the diagnosis of lipoma is confirmed, your doctor will discuss different treatment options available. This is typically only continued monitoring or surgical excision.
Sometimes patients are told “Don’t worry about that, it’s just a lipoma”. Unfortunately, the lipoma becomes more difficult to excise, recurrence risks increase, and the size of the scar and possible complications increase as these growths continue to enlarge. As well, there is always the possibility of a liposarcoma being misdiagnosed as a liposarcoma. Liposarcoma is a very serious and life threatening cancer. Liposarcoma needs to be diagnosed and treated early as it may metastasize and recurrence is even more common after excision than benign lipoma.
How is lipoma treated?
If small and without associated pain or tenderness lipomas may not require treatment. Instead, your surgeon may recommend keeping a watch on the size and shape of the lipoma (monitoring). A patient may also want to have the lipoma removed if there is a concern about its location or appearance.
A lipoma may cause pain or affect the function of a muscle. In such cases, it should be removed. Lipomas are usually self-limited, and they do not invade the surrounding tissues. Therefore, the surgeon usually makes a small incision in the skin over the area of growth just big enough so that the growth can be removed in one piece. Sometimes the lipoma is very irregularly shaped and grows into surrounding tissue by pushing that tissue aside. These are more difficult to ensure complete excision as the lipoma extends with branches or extensions in various directions. Recurrences after surgery are possible and those risks increase when careful excision is not performed. The patient should choose carefully and select a provider that is knowledgeable about the surgical excision. Recurrence risks increase with larger size of the lipoma and when the procedure is performed in an office setting and not a dedicated procedure room or OR. Possible side effects of excision may include scarring, bruising, and a post procedure fluid collection at the previous site of the mass called a seroma.
What is the expected recovery outcome after lipoma removal?
Lipoma excision is really always an outpatient procedure where the patient is discharged after the excision unless the lipoma is within the chest cavity (intrathoracic lipoma) or within the abdominal cavity (intra-abdominal lipoma). If the lipoma is large, a drain may be used to prevent body fluid from accumulating within the cavity that was created by excision of the lipoma. The drain is usually removed at the office follow up appointment. How long it takes to return to daily activities will depend on the size and location of the lipoma. If you have concerns about a lump or you are experiencing rapid growth or increasing tenderness, please bring this to the attention of a provider who performs these excisions. Dr. Williams and his team provide helpful post-surgical instructions to the patient to aid in faster recovery.