Dermatology-Online

When should a lipoma be removed?

definition

A lipoma is a benign tumor (tumor) of adipose tissue cells, also called Adipocytes are designated. They are surrounded by a capsule and can therefore be easily delineated from healthy tissue. They are most common around subcutaneous fatty tissue, that is subcutaneous. The occurrence of multiple lipomas is called Lipomatosis designated.

Emergence

The origin of lipomas has not yet been clearly clarified. It is assumed that there is a dysregulation in the differentiation of stem cells, which are precursor cells of connective tissue cells, into fat cells. They often form in the neck, on the spine, on the upper arm, in the armpit or on the thighs (lipoma thigh).

Indication for removal

Depending on the skin area, lipomas are only palpable when they are 1 cm in size. Most of the time, those affected do not express any complaints. Lipomas often last for years before they are discovered. Spontaneously, there can be faster and more space-consuming growth in size, so that they become visible and cause symptoms. These only occur with larger lipomas or the position of the lipoma is very unfavorable and affects other structures. If lipomas trigger symptoms, the indication is to remove them using one of the available methods.

For most people, lipomas are primarily a cosmetic problem if they are visible and difficult to cover with clothing. In addition, unpleasant pain can occur (see also: Pain from a lipoma). If neighboring structures such as nerves or blood vessels are functionally impaired by the size of the lipoma, it can also lead to neurological symptoms such as feeling of pressure, numbness, tingling or circulatory disorders. Then, at the latest, the lipoma should be surgically removed.
If lipomas are in unfavorable parts of the body, such as on the back or neck, they can be very annoying when sitting against the back of a chair or on the shirt collar. Lipomas the size of a child's head often occur on the flanks, and they cause discomfort when wearing certain items of clothing or when doing certain sports.

Read more on the subject at: Symptoms of a lipoma

Very rarely can the benign (benign) Lipoma the malignant (malignant) Develop liposarcoma. The suspicion can be confirmed by a histological (histological) Examination in which a tissue sample is examined under the microscope.

Can I remove a lipoma myself?

A lipoma is a mostly benign accumulation of fatty tissue under the skin or even deeper in the tissue, which can be removed by surgery or possibly by lipolysis (fat dissolution) in the event of symptoms.

During an operation, at least the skin must be cut open. If the lipoma is ultimately deeper in the tissue than expected, an experienced doctor must be careful not to damage any other structures, such as vessels and nerves or other organs. As a patient, you cannot of course perform an operation on yourself. An experienced doctor must also perform other procedures, such as lipolysis. The risk that the treatment will otherwise fail or cause further damage is simply too great for self-application.

Which doctor?

Removing a lipoma is a surgical procedure. Depending on where the lipoma is located on or in the body, it can be operated on by different doctors with surgical training.

Lipomas that are located directly under the skin can, for example, be operated on by a dermatologist. If there are several large lipomas in the abdomen and causing discomfort, you could contact a general surgeon. If the lipoma is very close to a vessel, the vessel may already have "grown around" the lipoma, then it is possible to seek help from a vascular surgeon.

The doctors mentioned can either perform this operation in their practice, if it is equipped for it, or there is the option of having the operation performed directly in a clinic.

treatment

In addition to the classic surgical removal of a lipoma, there are now also good alternatives that do not require an operation and also do not leave a scar or cause the skin to sink in after the tumor has been removed. The Injection therapy and the Laser lipolysis are two methods that can be done quickly and to the minimally invasive surgery counting.

Injection lipolysis

Treatment can outpatient be carried out and lasts about 15-20 minutes. A small fine needle is in the affected tissue in the Subcutaneous tissue introduced. The pain is very slight. Patients only feel one during treatment slight burning and To press in the area of the injected fine needle.
The drug is then injected slowly and should be evenly distributed so that it can target the lipoma. The drug is the Soybean lecithin and has been used for many years.

After the injection, the affected area of the skin is often swollen and reddened. This reaction should cause the fat cells to melt down in the coming weeks. The released fat is over the Bloodstream transported to the liver and there they are completely broken down. A Complete healing of the injection therapy can take up to eight weeks. If one session is not enough, the measure can be repeated.

Laser lipolysis

The Laser lipolysis can also be used to treat lipomas and complements the options of conventional liposuction. Laser lipolysis can outpatient and is therefore only performed under local anesthesia in some specialized medical practices and is painless for most patients.

Tiny skin incisions are first prepared for the application, which target the penetration of the laser fiber down to the Fat cells (Adipocytes) enable. A fine laser beam of the Diode laser is targeted on fat cells. Through the Laser beam generates heatwhich destroys the fat cells and dissolves the fat tissue. Simultaneously the heat generated desolates small blood vessels, so that the procedure is also relatively low-bleeding. The surrounding tissue becomes Formation of new collagen fibers stimulated by the skin-tightening effect of the treatment is explained.
Last but not least, this method is therefore the means of choice for reducing adipose tissue on smaller skin areas.

After treatment you can Redness and swelling occur. Since the heat generated can damage smaller skin nerves, numbness around the treated skin area can occur shortly after the procedure, but this will decrease as the healing process progresses.

Treatment with the laser not only offers the benefits of a Skin tightening, but one little blood loss Compared to classic liposuction and a short healing time also means only a short absence from work. It is gentle and low-risk.

The anesthesia

At larger lipomas or one Variety of lipomas it is sometimes necessary to take the distance general anesthetic perform. A short anesthetic is more comfortable for the patient than multiple punctures with a local anesthetic, especially when resecting some lipomas.

Of course, an anesthetist should first clarify whether the patient is suitable for anesthesia. In addition to a detailed anamnesewho the Measurement of vital parameters and the Drug status collects another blood test, usually one more EKG and an education about general anesthesia carried out. The patient must give his consent to the measure.

The anesthesia is initiated by the anesthetist and assisting nurses. The patient receives maximum oxygen through a mask. The anesthetic is injected through an intravenous line, usually in the arm. These drugs are Propofol or one Painkiller (analgesic). The patient becomes increasingly tired, feels dizzy and eventually falls asleep.
After the patient falls asleep, the anesthetist can give him a Breathing tube (Tube) intubated. Thereby the Ventilation of the patient secured. Vital parameters are consistently checked on a monitor for the duration of the procedure.
Towards the end of the operation, the medication is reduced and the patient wakes up. If he is awake enough and can breathe himself, the tube is removed and then observed for a few hours in the recovery room in order to identify the after-effects of the operation and the anesthesia at an early stage. It can then be moved to a ward.

Risks and complications of the operation

In surgery, the removal of the lipoma is one of the Routine interventionsHowever, as with any surgery or treatment, complications can arise. Which complications occur in detail depends, among other things, on the method.

Every skin incision basically contains the Risk of infection to develop. If bacteria get into the wound, it can become infected and healing is slow and worse. The typical signs of inflammation Redness, swelling, warming and Pain can occur. After an inflammation there is also the risk that the cut edges will adapt more poorly and a larger scar will form.

During the operation or with the other treatment options, it can lead to Injury to nerves come. The severity of the symptoms then depends largely on the extent of the damage to the nerve fiber. Symptoms like tingle, Loss of sensitivity, Numbness can be the result.

Treatment under anesthesia or with local anesthesia can lead to intolerance reactions to the drugs used. It is therefore important for both methods that the patient is monitored and that an allergic reaction can be responded to quickly.

In addition to the risks and complications mentioned, there can be possibly also to a new formation of the lipoma come. In this case one speaks of a Relapse. Then another intervention is necessary.

Scars after surgery

The removal of a lipoma using the classic surgical method requires a skin incision, which generally carries the risk of scarring. Whether and how big a scar develops is basically also related to the constitution of the skin and genetic factors.

Read more on the topic: Scar care

The patient should ensure good follow-up care so that healing can take place without complications and the incision is barely visible. The wound should be kept clean and dry and provided with appropriate wound and dressing material on a daily basis. In addition, depending on the location of the surgical wound, high loads or pressure increases should be avoided so that the edges of the skin can adapt and grow together.
If the wound is well closed, it should not be exposed to direct sunlight. Otherwise, skin discoloration may result in a more visible scar. Scar ointments, which are available in the pharmacy, can then be applied regularly. They keep the skin supple and prevent the scar tissue from overgrowing (colloid).

If serious complications arise in the healing process, such that a scar does not look cosmetically appealing and the patient is very dissatisfied, the option of cutting out the scar again and resecting the tissue can be considered. Healing again can, under favorable circumstances, lead to a better result.

The minimally invasive interventions such as injection lipolysis and laser lipolysis, on the other hand, do not leave any visible scars. The incisions that are needed for treatment are very small and heal quickly and well. During the treatment, the doctor should make sure that the treatment is done evenly and across the surface so that behind the skin area is even and smooth. After the swelling has subsided, the skin should be firm and free of dents.

Cost of treating a lipoma

The cost depends on the choice of Depending on the method and the number of lipomas present. The assumption of costs or the proportion of the deductible can also differ from one health insurance company to another. Many do not reimburse the costs. Several lipomas can be removed during one treatment as long as the patient tolerates it or several sessions are necessary. As the number of lipomas increases, so do the costs. The Injection lipolysis has an initial price of approx. € 240-260. The cost of treatment with the laser are included about 360 €. Here, too, the removal of the first lipoma is calculated to be higher than the resection of further lipomas.

How long have I been on sick leave?

How long a sick note will be issued after lipoma removal cannot be generally stated for all procedures. It depends very much on how big the lipoma is and where it is in the body. The operation can range from a small skin incision to a major abdominal surgery.

You should definitely not work on the day of the operation, especially if you have been given general anesthesia for the operation. If you have coped well with the operation, all you have to do is heal the skin well. Otherwise, it is of course relevant which profession you practice and whether, for example, a bandage on your arm is already preventing you from doing it.