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A lipoma is a benign lump made of mature fat cells that grows slowly under the skin. It is usually felt as a soft, rubbery nodule that slides easily under the fingers and is painless in most cases. Lipomas are among the most common soft-tissue lumps, appearing most often on the back, shoulders, neck, arms and thighs, either singly or as multiple lumps. Not every lipoma needs treatment. Removal is considered when the lump is painful or presses on a nerve, when it grows quickly, when its size restricts movement or clothing, when it sits where it is rubbed or pressed, when it bothers the patient cosmetically, or when the diagnosis is uncertain and tissue examination is required. Otherwise, observation is a perfectly acceptable option. Assessment begins with clinical examination: size, consistency, mobility and the relationship of the lump to skin and muscle. Ultrasound may be requested for unclear lumps, and more detailed imaging for large or deep lumps inside muscle or close to important vessels and nerves before any removal. Features that call for deeper assessment before a simple excision is planned include a hard lump, one fixed and not mobile, rapid growth, pain, an unusually large size, or a lump lying deep beneath the muscle layer, because other soft-tissue masses can look like a lipoma while being entirely different in nature; imaging and histology are what separate them. The mainstay of treatment is complete surgical excision together with the capsule. In most cases this is done under local anaesthesia in the clinic through an incision roughly matching the length of the lump, and the specimen is sent for histological examination. Large or deep lipomas, or those near important structures, are removed in the operating room and may need deeper anaesthesia and a temporary drain. Limits of the procedure: no cream, tablet or injection dissolves a lipoma, and dieting or weight loss does not remove it, because its cells do not respond like ordinary body fat. Liposuction can reduce the bulk through a smaller incision, but it leaves the capsule and cells behind, so recurrence in the same site is more likely, and it does not provide a complete specimen for examination. Removing one lipoma does not prevent others from appearing, particularly in people with multiple lipomas or a family tendency. Any removal leaves a surgical scar, and the position and shape of the incision should be discussed before you consent.
The doctor measures the lump and assesses its consistency, mobility and relationship to the skin, and asks how long it has been there, how fast it has grown, and about pain or numbness. The findings are compared with other common lumps in that area before a plan is made.
Ultrasound is requested for atypical lumps and more detailed imaging for large or deep lesions, or those near nerves and vessels. The aim is to define extent and depth and to rule out anything that is not a lipoma before an incision is made, since a wrong assumption complicates treatment.
The area is cleaned and the skin and surrounding tissue are anaesthetised locally, and the incision is planned along natural skin lines where possible to minimise the visible scar. Large or deep lumps are dealt with in the operating room, possibly under deeper anaesthesia.
The lipoma is separated from surrounding tissue and removed intact with its capsule, sparing nearby nerves and vessels. Bleeding is controlled, a small drain may be left after large excisions to prevent fluid collection, and the layers and skin are then closed with fine sutures.
The specimen is sent to the laboratory to confirm its benign nature, and this step is never skipped. The result is reviewed with you at follow-up, the wound is assessed, sutures are removed if needed, and you are given advice on scar care.
Tell the doctor when the lump appeared, whether it has changed in size or consistency, whether it hurts or causes numbness, and whether you have other similar lumps or a family history of them. Report all your medicines, especially blood thinners and antiplatelet drugs, and do not stop any of them yourself; ask about safe timing instead. Mention any drug allergy, reaction to local anaesthetic, adhesive dressings or antiseptics, and any chronic illness, particularly diabetes or immune problems, since these affect healing. Do not squeeze, pierce or treat the lump with home remedies before it is assessed. Shower and clean the area before your appointment, wear loose clothing that gives easy access to the site, and arrange transport if the procedure is booked in the operating room.
Keep the dressing clean and dry for as long as your doctor advises, and change it exactly as demonstrated without touching the wound with unwashed hands. Expect swelling, bruising and tightness at the site, and a small fluid collection may form under the skin after removal of a large lump; never try to drain it yourself. Use the simple pain relief your doctor recommends, and avoid stretching the area, heavy lifting or exercise that strains the nearby muscle for roughly one to three weeks depending on the site and the size of the lump. Do not soak the wound in a bath, pool or the sea until permitted. Once the wound has healed, protect the scar from sun for several months to limit darkening. Attend follow-up to hear the histology result; the lump disappearing is not the end of the process. **Seek care immediately if you develop: spreading redness, warmth, pus or odour from the wound; high fever or shivering; sharply increasing pain; rapid swelling or bleeding that does not stop with pressure; wound opening; new numbness or weakness in the area; or a lump returning at the same site.**
Usually 20 to 45 minutes for superficial lumps under local anaesthesia, extending to one or two hours for large or deep lipomas in the operating room.
Dr Dawoud Mahmoud Dawoud is a specialist in general, bariatric and laparoscopic surgery and holds the Jordanian Board in General Surgery. He sees patients in Ja…
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