eMedicine Specialties > General Surgery > Abdomen

Lipomas: Treatment

Author: Todd A Nickloes, DO, Assistant Professor of Surgery, Division of Trauma/Critical Care, University of Tennessee Medical Center
Coauthor(s): Daniel D Sutphin, MD, Chief Resident, Department of General Surgery, University of Tennessee Memorial Medical Center; Klaus Radebold, MD, PhD, Research Associate, Department of Surgery, Yale University School of Medicine
Contributor Information and Disclosures

Updated: Jan 15, 2009

Treatment

Medical Therapy

  • Medical therapy includes endoscopic excision of tumors in the upper gastrointestinal tract (ie, esophagus, stomach, duodenum) or the colon.
  • Colonoscopic snare removal has been described but may be associated with perforation if the base is broad.
  • Japanese authors reported a safe technique in which a bipolar snare was used and the mucosa of the defective region was clipped.12 Otherwise, surgical removal is indicated.

Surgical Therapy

Complete surgical excision with the capsule is advocated to prevent local recurrence, whether the lipoma in question is subcutaneous or intracardiac in origin. These lesions may be lobulated, and it is essential that all lobules be removed. 

Specific therapy depends on the location of the tumor.

Subcutaneous lipomas are removed for cosmetic reasons, and hence, a cosmetically pleasing incision should be used. The incision is usually placed directly over the mass and is oriented to lie in a line of skin tension. Liposuction is an alternative that allows removal of the lipoma through a very small incision, the location of which may be remote from the actual tumor.13,14,15,16 The lesion may also be approached with advanced, minimal-access tissue dissection methods, using a dissecting balloon.17 The latter 2 methods allow the incision to be placed in an inconspicuous location. For example, axillary incisions may be used to remove lipomas from the back.

For more unusual locations, the method of removal must be tailored to the site and may require the expertise of a consultant.

  • Local removal is indicated in intestinal lipomas causing obstruction or hemorrhage. Uncertainty of diagnosis for an intramural intestinal mass also warrants resection, because liposarcomatous disease of the bowel has been described.
  • If esophageal lipomas cannot be endoscopically removed, surgical excision is indicated, whether by a transhiatal or transthoracic approach.
  • Lipoma-related narrowing of the major airways warrants removal of the instigating mass. Likewise, intraparenchymal lipomas of the lung may require thoracotomy and the expertise of a thoracic surgeon.
  • Breast lipomas are excised if their nature is in doubt, whether by means of wire or ultrasonographic localization or by means of direct palpation.
  • Vulvar lipomas may be locally excised.
  • Lipomas in critical locations, such as the heart, may require a more physiologically and technically demanding procedure for removal, including median sternotomy with bypass.
  • Intraosseous lipomas may be removed utilizing endoscopic means in combination with orthopedic expertise.

Related eMedicine topics:
Benign Vulvar Lesions
Liposuction, Techniques

Preoperative Details

Because all lipomas are radiolucent, findings on soft-tissue radiographs can be diagnostic but are only indicated when the diagnosis is in doubt.

Intraoperative Details

  • Tumors can usually be enucleated. They may recur if not properly removed, and this includes removal of the capsule.
  • Hibernomas tend to be highly vascular.
  • Lipomas in other locations may present unique difficulties during removal; for example, in a person presenting with a frontalis-associated subfascial lipoma as a protruding mass on the lateral forehead, the lipoma may be difficult to dissect because of the highly vascular muscle that invests it.
  • Lipomas of the gastrointestinal tract can frequently be shelled out of their submucosal location. The duodenal lipoma shown in Images 1-2 was excised with a disk of overlying ulcerated mucosa.

Follow-up

The patient should consult a physician if signs of recurrence appear.

Complications

Subcutaneous lipomas are primarily cosmetic issues. Lipomas in other locations may cause luminal obstruction or hemorrhage. Images 1-2 illustrate a duodenal lipoma that caused gastrointestinal hemorrhage and required removal.

More on Lipomas

Overview: Lipomas
Workup: Lipomas
Treatment: Lipomas
Follow-up: Lipomas
Multimedia: Lipomas
References
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References

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Further Reading

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Keywords

lipoma, lipomas, liposuction, liposarcoma, fatty tumor, fatty tumors, lipoma removal, angiolipoma, lipomatous, pseudolipoma, teratoma, adenolipomas, hamartoma, cardiac lipomas, soft-tissue tumor, benign tumors of fatty tissue, benign small neoplasms, submucosal tumors of adipose tissue, duodenal lipomas, colonic lipomas, lipoblastomas, hibernomas, esophageal lipomas, intussusception, intestinal lipomas, intestinal obstruction, intramuscular lipoma, pediatric lipoblastomas, benign mesenchymal tumors, lipomas of the lung, breast lipomas, subcutaneous lipomas, lipomas of the vulva, frontalis-associated subfascial lipoma

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Contributor Information and Disclosures

Author

Todd A Nickloes, DO, Assistant Professor of Surgery, Division of Trauma/Critical Care, University of Tennessee Medical Center
Todd A Nickloes, DO is a member of the following medical societies: American College of Osteopathic Surgeons, American Medical Association, American Osteopathic Association, Association for Academic Surgery, Eastern Association for the Surgery of Trauma, Society of Critical Care Medicine, Society of Laparoendoscopic Surgeons, Southeastern Surgical Congress, and Southern Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Daniel D Sutphin, MD, Chief Resident, Department of General Surgery, University of Tennessee Memorial Medical Center
Disclosure: Nothing to disclose.

Klaus Radebold, MD, PhD, Research Associate, Department of Surgery, Yale University School of Medicine
Klaus Radebold, MD, PhD is a member of the following medical societies: American Gastroenterological Association and New York Academy of Sciences
Disclosure: Nothing to disclose.

Medical Editor

Juan B Ochoa, MD, Assistant Professor, Department of Surgery, University of Pittsburgh
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

David L Morris, MD, PhD, Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other; AstraZeneca Grant/research funds Other

 
 
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