Lipomas Treatment & Management

  • Author: Todd A Nickloes, DO, FACOS; Chief Editor: John Geibel, MD, DSc, MA   more...
 
Updated: Mar 16, 2010
 

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.[15] Otherwise, surgical removal is indicated.

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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.[16]

Subcutaneous lipomas are removed for cosmetic reasons, and hence, a cosmetically pleasing incision should be used.[17] 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.[18, 19, 20, 21] The lesion may also be approached with advanced, minimal-access tissue dissection methods, using a dissecting balloon.[22] 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.
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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.

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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 under Complications was excised with a disk of overlying ulcerated mucosa.

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Follow-up

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

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Complications

Subcutaneous lipomas are primarily cosmetic issues. Lipomas in other locations may cause luminal obstruction or hemorrhage. The images below show a duodenal lipoma that caused gastrointestinal hemorrhage and required removal.

Upper gastrointestinal series shows duodenal lipomUpper gastrointestinal series shows duodenal lipoma with central ulceration where the overlying mucosa has thinned, ulcerated, and bled.Duodenal lipoma resected through a duodenotomy. OvDuodenal lipoma resected through a duodenotomy. Overlying mucosa with central ulceration removed and lobulated fatty tumor shelled out intact with capsule. The mucosa was then sutured closed, and the duodenotomy closed. The stitch was placed to orient the specimen for pathologic examination.
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Outcome and Prognosis

The outcome and prognosis are excellent for benign lipomas. Recurrence is uncommon, it may happen if the excision was incomplete.

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Future and Controversies

Liposuction may be employed more often in small facial lipomas, because favorable aesthetic results have been obtained through strategically placed incisions. Liposuction is indicated for the treatment of medium (ie, 4-10 cm) and large (ie, >10 cm) lipomas; in small lipomas, no advantage has been reported, because these tumors can be extracted through small incisions.[18, 19, 20, 21]

Lipoma formation has been reported as an unusual complication of liposuction and has also been found to occur following trauma.[3, 23] The mechanism in these cases is unknown. Research on genetic markers of atypical lipomatous tumors and liposarcomas is ongoing. These tumors have been shown to express receptors for leptin.[24]

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Contributor Information and Disclosures
Author

Todd A Nickloes, DO, FACOS  Assistant Professor, Department of Surgery, Division of Trauma/Critical Care, University of Tennessee Medical Center-Knoxville

Todd A Nickloes, DO, FACOS 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  Resident Physician, Department of Plastic Surgery, University of Tennessee College of Medicine Chattanooga

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.

Specialty Editor Board

Juan B Ochoa, MD  Assistant Professor, Department of Surgery, University of Pittsburgh; Medical and Scientific Director, HCN, Nestle Healthcare Nutrition

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

David L Morris, MD, PhD, FRACS  Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia

David L Morris, MD, PhD, FRACS is a member of the following medical societies: British Society of Gastroenterology

Disclosure: RFA Medical None Director; MRC Biotec None Director

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 Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, 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 Consulting; ARdelyx Ownership interest Board membership

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Upper gastrointestinal series shows duodenal lipoma with central ulceration where the overlying mucosa has thinned, ulcerated, and bled.
Duodenal lipoma resected through a duodenotomy. Overlying mucosa with central ulceration removed and lobulated fatty tumor shelled out intact with capsule. The mucosa was then sutured closed, and the duodenotomy closed. The stitch was placed to orient the specimen for pathologic examination.
 
 
 
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