Dermatology-Online

Lipoma

Synonyms in a broader sense

Adipose tissue tumor, fat, tumor, skin, adipose tissue growth

English: lipoma, fatty tumor, adipose tumor

Definition of lipoma

Under a lipoma (Adipose tissue growth) one understands soft or elastic knots lying under the skin.
The skin overlying the lump is normal and intact. The size of these nodes varies widely.
They can be the size of a pea or larger. These nodes have their origin in the fat cells of the subcutaneous fat tissue. The lipoma is a benign growth that is characterized by very slow growth.

In addition to lipomas, there are also so-called pie-drawn nodules - fat nodules that develop under high pressure - which must be clearly delimited.
For more information, read our article: Peeled Nodules - How Dangerous Are They?

causes

A secured one root cause does not exist at the moment. As with most tumors, you assume one genetic degeneration of certain cells - in this case Fat cells (Adipocytes) - out. These fat cells seem to multiply and form a knot.
Some of the sick people can get a Change on chromosome 12 find that this also suggests a hereditary component. They may also be responsible for the development of the lipoma Stem cells responsiblethat normally develop in stem cells.

Furthermore could various other diseases play a role in the development of the lipoma. especially the Diabetes and Lipid metabolism disorders (e.g. hyperlipidemia) are suspected of promoting the development of a lipoma. Such connections are however not adequately investigated. It is also assumed that strong impacts or Bruises a lipoma can develop. In contrast, the cause can be safely ruled out obesity (Obesity), thin people have a lipoma as often as overweight people. In certain genetic diseases, the lipoma occurs in multiple forms, i.e. the patient has many lipomas at the same time. Examples here are the Lipomatosis dolorosa (Dercum's disease).

Illustration of a lipoma

Lipoma - adipose tissue growth
a - epidermis (2 + 3 + 4) -
epidermis
b - dermis (5 + 6) -
Dermis
c - subcutaneous tissue (7) -
Tela subcutanea

Lipoma -
Adipose tissue growth
Horny layer - Stratum corneum
Cornifying layer
(light layer
and granular layer) -
Stratum lucidum and
Stratum granulosum
Germ layer (prickly cell layer
and base layer) -
Stratum spinosum and
Stratum basale
Papillary layer -
Stratum papillary
Network layer -
Stratum reticularre
Fat tissue (fat pads)
Fat cells - adipocytes

You can find an overview of all Dr-Gumpert images at: medical illustrations

Symptoms / complaints

A benign lipoma does not usually cause any symptoms, so it is often only discovered when the lipoma has reached a certain size.
They stand out as soon as you can feel or see them.

Read more on the topic: Swelling on the side of the neck

The lipoma goes along without pain. They can only cause pain if they are in an awkward place - for example near nerves - and press on them. See also: pain with a lipoma

In their consistency, they are either soft or elastic and lie directly under the skin.
The lumps can be pushed back and forth under the skin. The benign nature of the tumor (lipoma) is based on this mobility.

Read more on this topic at: Symptoms of a lipoma

Localization by body region

Lipoma on the back

The back is one of the most common locations of the lipoma. The lipoma is rather in an unproblematic place on the back, because there little can happen. If you touch the lipoma, palpable findings of very soft to very hard to be possible. However, it is mostly soft and easy to move. In the case of a rough, hard palpation, it should be clarified whether it is a lipoma or a Liposarcoma acts, as the latter also feels hard.

The size of the lipoma on the back can vary widely, ranging from the size of a lens and barely palpable to Fist-sized and clearly visible and palpable. The lipoma usually does not cause any problems on the back. From a certain size it can be used as a unaesthetic be felt. Physically it can be from a certain size too Friction and feeling of pressure come. In addition, the size of the lipoma on the back can cause it to lie next to or under it annoy to press. This can lead to sensory disturbances or a numbness in the area skin occur. It can also cause nerve irritation or pain Pressure on tendons and muscles come.

Do you have a lipoma? Spine and such complaints occur or the lipoma is perceived as an aesthetic burden, so this is recommended distance. This is uncomplicated and straight on the back well feasible. The removal of the lipoma can be done by the family doctor or resident surgeon or in the hospital. Usually a Local anesthesia, that means an anesthetic of the affected area is carried out. Then the lipoma is cut out. Since it mostly well encapsulated it works well. However, a scar can remain, and the removal of a lot of tissue (in the case of a large lipoma) form a dent in the further course. There are various techniques that can be used to prevent dents from forming, but this is not always successful. If you have a very large lipoma or if the location is unfavorable, you can also have a Operation under general anesthesia contemplate.
The scar that occurs on the back after a lipoma operation can be partially affected visually more conspicuous be than the removed lipoma. As with any operation, the surgical removal of the lipoma occurs on the back certain risks and side effects. For example, the anesthetic can have side effects, and with every operation there is the risk that even if the hygiene and disinfection measures are observed Infection of the wound arises. Especially on the back, where the lipoma can become quite large without causing problems early on, the lipoma can also be caused by the Method of liposuction remove. This procedure results in significantly less scarring because only small tubes have to be pushed through the skin and no large incisions are made. In addition, the suction is regulated so that mostly no dents arise. However that is complete removal of the lipoma difficult by suction, since one usually does not reach all cells. There is a very high probability that new lipomas will grow from the cells that have remained The likelihood of relapse is therefore high elevated.

Lipoma on breast

In slim women and women with smaller breasts, it can happen that they discover the lipomas themselves. They present themselves as rather soft structures and go from the Adipocytes from (adipose tissue cells). Lipomas sometimes grow very slowly and it can take several years to reach their final size. The diameter can become so large that the lipoma appears as a bulge under the skin. In principle, lipomas in the breast do not increase the risk of cancer. However, if a soft mass is noticed, a medical examination should follow. An experienced doctor can already determine whether it is a lipoma with ultrasound and scanning or mammography. However, since a complete diagnosis is not possible from the outside, a Breast biopsy is appropriate to rule out possible malignant degeneration.

In women over the age of 50, a further investigation is urgently indicated in order to rule out malignant degeneration, because in this group of women after the menopause, the lipoma is one of the most common neoplasms. The lipomas arise in the fatty tissue under the skin on the breast or partly in the glandular body. In combination with connective tissue cells, they are called Fibrolipomas and in combination with gland cells as Adenolipomas.

Often lipomas regress over a few years. Nevertheless, gynecological monitoring should take place in order to perceive possible changes that speak for a prognostically unfavorable course and to be able to intervene if necessary. If the lipomas take on a size that is uncomfortable for the patient, surgical removal can also be carried out. A resection should then also take place for safety reasons.

Read more on this topic at: Lipoma on the breast

Lipoma on the thigh

Lipomas on the thigh include the head, neck, back and torso more common places. When they occur on the lower extremity, however, they mostly are located lower - So not to be found in the superficial layers of the skin. There are so-called infiltrating lipomas. These are lipomas that intra- or intermuscular are found (in a muscle or between different muscles). Lipomas on the thigh are not a problem. However, if they can reach a certain size Paresthesia occur. This happens due to an unfavorable location in which the Lipoma presses on a nerve. Removal of a lipoma on the thigh, when it needs to be done, is a straightforward procedure.

Lipoma on the neck

Since there is fatty tissue on the neck, a lipoma can also develop here. Unfortunately there is on the neck not much space for a spreading tumor, therefore structures in the immediate vicinity are quickly impaired. One possible complication is a neck, for example Pressure on the carotid artery (Carotid artery). On the neck, the Muscles be restricted in their mobility or it can be caused by the Pressure on nerves running there come to pain. Since these symptoms occur more often on the neck than on the back, for example, due to the anatomical conditions, lipomas are on the neck more often removed. The surgical removal of the lipoma conceals in the throat and neck area more risks, because many sensitive structures are in a small space. There are therefore complications Nerve damagewhich can lead to sensory disturbances, for example.

Lipoma on the head

Patients usually only perceive lipomas in the head area when they are already of a certain size, since the "knobs" are simply not noticeable beforehand due to their small size. Step under all areas of the body Lipomas most often in the head area on. They can be found in different places in the head and neck area. You can do it subcutaneousi.e. directly under the skin, or under the muscle fascia, i.e. they lay within the connective tissue capsulethat surround the muscles.

Common sites are subcutaneous lipomas in the neck area and subfascial lipomas in the Transition from forehead to hair.( Read more on the topic: Lipomas on the face and forehead).
Lipomas on the head can arise from different precursors, i.e. develop from different cell types. Basically, lipomas on the head are more likely than harmlessas they almost never metastasize or are malicious. However, if a lipoma in the head area is very unfavorable, the lipoma can become inflamed. In such cases a doctor should be consulted. Basically, a known lipoma should be checked regularly, even if there is almost no tendency to degenerate. A lipoma on the head can be removed, the reasons for this being more likely that the patient feels disturbed - that is, more cosmetically justified.

diagnosis

The diagnosis The lipoma is usually done by palpation and assessment of the mobility of the tumor. (tumor In this context - and otherwise - simply means swelling.) An exact diagnosis is usually ensured by puncture. The exact size is in Ultrasonic detected.
Here you can differentiate the fatty tissue from other changes. Adipose tissue appears whitish on sonography (ultrasound), while cysts would appear black or dark. A cyst is a fluid-filled cavity.

Complications

Because lipoma is a benign ulcer, complications are rare. However, the fatty growths can recur after removal.

In the operative removal of the lipoma, general surgical complications such as bleeding, infections, damage to vascular and nerve structures and wound healing disorders can occur.

Inflammation of a lipoma

When a lipoma is so located that it is constantly exposed to friction or pressure irritation may cause it to become infected. With the entry of bacteria in the lipoma it comes to Formation of pus. The pus can leak out when the lipoma ruptures. The inflammation can spread, the suitably symptom-free lipoma begins to make itself felt. The skin becomes red and the inflammation causes a reddening Feeling of pressure and pain. If a lipoma gets infected you should remove. This prevents further inflammation. However, once the lipoma is removed, there is a high probability that a new lipoma will form in the same place.

Therapy of a lipoma

A Lipoma can be removed - but does not have to, as it does not tend to degenerate in a malicious manner.
If the diagnosis is uncertain, it should be removed as a precaution, as the diagnosis can only be confirmed under the microscope.

Depending on the size, it will be under local or anesthesia general anesthetic away. In contrast to malignant tumors, there is no need to pay attention to safety distances when removing them.

Since a lipoma is easy to see or feel, only a small incision is usually necessary. No special further treatment is required, as the relatively small wounds can be sutured up easily.

Everyone removed tumor must be examined again in small parts under the microscope (tissue examination) in order to be able to safely rule out malignancy.

How to remove a lipoma

From a medical point of view, removal of a lipoma is not necessary in most cases. Since lipomas are very slow and non-invasive growing, the The risk of metastasis and the development of a malignant tumor is very low. From a cosmetic point of view, a lipoma can be removed. Especially when the lipoma is in a place where it is bothersome to the patient, e.g. in a joint region, or where it interferes for aesthetic reasons, e.g. in the face or hand area.

In local anesthesia (local anesthesia), the skin is opened at the respective point with a scalpel. The lipoma is "pushed out" through the skin gap and can then be cut away. It is important to ensure that the lipoma has a strong blood supply, which is why the vessels pulling into the lipoma should be clamped off to avoid bleeding. At the point where the lipoma was located, there is now an empty space, the extent of which is determined by the amount of tissue that was cut out. In cases where this space is so large that a dent will appear, fatty tissue can be transplanted there from another location.

It can also be used for cosmetic reasons excess skin removed caused by the fact that the bulge that made the lipoma is no longer there. Should it be a subfascial or intramuscular If the lipoma is located, the surgeon must prepare further in depth and also the Split muscle fascia and possibly muscle. In these cases the operation may take longer. If it turns out that the operation will take longer or become more complicated, general anesthesia can be used instead of local anesthesia.

Instead of surgical removal, a lipoma can also have a Liposuction be treated. There is no complete removal from the lipoma. Instead, the contents of the connective tissue capsule that surrounds the lipoma are aspirated as much as possible. The capsule and remnants of the lipoma cells, however, remain in place. A suction is usually only possible with larger lipomas, as smaller lipomas usually still have a very hard consistency.

Of the advantage suction is due to the cannulas used no scars arise. This is very interesting, especially from a cosmetic point of view. Furthermore, there is less chance of dents in the skin because the capsule is left behind and thus stabilizes the area.

disadvantage the suction, however, is that not all cells removed become. This results in the risk that the lipoma will grow again and will have to be suctioned off again after a certain time. In addition, the pathological assessment of lipoma cells after suctioning is much more difficult, since many cells are destroyed by the mechanical pressure during suction.

prophylaxis

Since the trigger for the degeneration of the fat cells has not yet been found, but a genetic component seems to play a role, prophylaxis is not possible.

forecast

The forecast is good. The removal intervention is in itself straightforward. Complications such as bleeding and infection are rare.
However, the lipoma can recur. These recurrences (recurrence of a lipoma) are almost always as benign and harmless as their predecessors.

Summary

A Lipoma is a benign growth of adipose tissue. Their consistency is soft or resilient.
As a rule, the lipoma does not cause any discomfort, nor are lipomas painful. Removal is therefore only necessary for cosmetic reasons. In most cases, these lumps appear on the arms, legs, and trunk.

In extremely rare cases, tumors made from fat can also be malignant. They are then called Liposarcomas.

The age at which a lipoma occurs most frequently is between the ages of 20 and 25.
The growth is very slow. Several of these lipomas can appear over time. If these are close together one speaks of a Lipomatosis. Here, too, different forms can be distinguished.