What are the indications and procedure for lipoma (benign tumor composed of adipose tissue) excision on the anterior chest wall?

From the Guidelines

Lipoma excision on the anterior chest should be performed with careful consideration of the potential for atypical lipomatous tumors (ALT), and MRI with expert review or molecular demonstration by fluorescence in-situ hybridisation of amplification of the MDM-2 cell cycle oncogene may be necessary to differentiate between lipomas and ALT 1. When excising a lipoma on the anterior chest, it is essential to follow a systematic approach to ensure complete removal and minimize complications.

• Preoperative evaluation should include a thorough history and physical examination to assess the size, location, and characteristics of the lipoma.
• Imaging studies such as MRI may be necessary to differentiate between lipomas and ALT, especially in large or deep-seated tumors 1.
• The procedure typically begins with local anesthesia using lidocaine 1-2% with epinephrine, injected around the lipoma.
• After proper sterilization of the area with povidone-iodine or chlorhexidine, the surgeon makes an incision directly over the lipoma, following skin tension lines to minimize scarring.
• The lipoma is then carefully dissected from surrounding tissues and removed intact when possible.
• The wound is closed with absorbable sutures for deeper layers and non-absorbable sutures or adhesive strips for the skin.
• Post-procedure care includes keeping the wound clean and dry for 24-48 hours, then gentle cleaning with mild soap and water.
• Patients should watch for signs of infection such as increasing pain, redness, swelling, or drainage.
• Sutures are typically removed after 7-14 days depending on the size of the excision.
• The procedure is generally safe with minimal complications, though patients should be aware of potential risks including infection, bleeding, scarring, and rare recurrence 1. It is crucial to note that the prognosis for ALT is mostly excellent with surgical resection, and marginal resections can give excellent rates of long-term local control 1.
• In older patients, if surgery is likely to be morbid or the patient has significant comorbidities, radiological surveillance can be considered.
• In larger tumors, or those where clear margins are difficult to achieve, adjuvant radiotherapy may occasionally be considered 1.

From the Research

Lipoma Excision on the Anterior Chest

• Lipoma excision can be performed using various techniques, including local anesthesia and tumescent local anesthesia 2.
• The use of ultrasound-guided regional blockade for lipoma excision has been shown to reduce the number of needle passes required to complete the block and provide less procedure-related pain and longer pain relief compared to traditional block 3.
• Tumescent local anesthesia can be used to excise large lipomas in an outpatient setting, with minimal complications 2.
• Lipomas are typically benign tumors that can be left alone, but rapidly growing or painful lipomas can be treated with excision or other procedures 4.
• Intralesional injection of triamcinolone acetonide can be an effective alternative to surgical excision for painful subcutaneous lipomas, with significant reduction in lipoma dimensions and symptoms 5.
• The use of virtual reality and communication intervention can help reduce pain and anxiety in patients undergoing lipoma excision with local anesthesia 6.

Anesthesia and Pain Management

• Ultrasound-guided lipoma plane blockade can provide effective anesthesia and pain management for lipoma excision 3.
• Tumescent local anesthesia can be used to provide adequate anesthesia for large lipoma excision 2.
• Intralesional injection of triamcinolone acetonide can reduce lipoma size and symptoms, avoiding the need for surgical excision 5.
• Virtual reality and communication intervention can be used to reduce pain and anxiety in patients undergoing lipoma excision with local anesthesia 6.

Surgical Techniques

• Lipoma excision can be performed using various surgical techniques, including traditional excision and tumescent local anesthesia 2.
• The use of ultrasound-guided regional blockade can facilitate technically easier block placement and reduce procedure-related pain 3.
• Intralesional injection of triamcinolone acetonide can be an alternative to surgical excision for painful subcutaneous lipomas 5.