LIPOMA REMOVAL

A classic lipoma is soft, rubbery, moves freely under the skin and grows very slowly. They favour the shoulders, back, arms and thighs; they tend to run in families, and having more than one is common. When a lump has all of those features, a surgeon can be confident. When it does not, the honest answer is that it needs looking at properly.

The features that change the conversation are a lump that is firm rather than soft, one that is fixed to the tissue underneath rather than movable, one that is growing quickly, one that is painful, and one that is deep or unusually large. None of those means something sinister, and the great majority turn out to be entirely benign, but they are the reason we examine before we operate and send tissue to the laboratory when it is warranted.

There is no obligation to remove a lipoma, but there are good reasons to have one looked at.

• It is growing, particularly if it has changed noticeably over a few months.
• It is painful or tender, which is not typical for a simple lipoma.
• It feels firm, or fixed to the tissue underneath rather than moving freely.
• It catches or gets knocked on a waistband, strap, collar or the back of a chair.
• There are several, which is common and worth a conversation rather than a worry.
• You simply want it gone. Appearance is a legitimate reason, and we will not make you justify it.

A lump that has appeared quickly, feels hard, or is fixed in place should be assessed promptly rather than at your convenience. That is not a reason to panic; it is a reason to book.

Under local anaesthetic, through the smallest incision, the lump is removed. The area is numbed, the skin is opened over the lipoma, the capsule is separated from the surrounding fat, and the whole thing is lifted out in one piece. The space it leaves is closed and the skin sutured. Where a lump warrants it, the tissue is sent to Nationwide Pathology, an accredited laboratory.

Removing it whole is what stops it coming back. A lipoma broken up and pulled out in pieces leaves fat cells behind, and those can regrow. A clean removal is close to definitive.

The incision is usually shorter than the lump is wide, because fat is compressible and a surgeon can deliver a lipoma through a smaller opening than its diameter suggests. That is a technique question, and it is the difference between a two centimetre scar and a five centimetre one. Larger and deeper lipomas need a bigger incision, and we will tell you what to expect before you agree to anything.

Keep the wound dry for the first 48 hours. Most people go back to normal the same day, sutures come out around 7 to 10 days, and exercise waits two weeks or so, depending on the site and size. A lipoma removed from a back or shoulder takes longer to be comfortable than one from a forearm, because the skin there is under more tension.

Expect a firm ridge along the scar for several weeks, which is normal healing rather than the lipoma returning, and the scar keeps improving for months. Bruising is common with larger ones, because there is a space left where the lump was. You leave with wound care advice, a suture removal appointment where needed, and a named contact if anything concerns you.