From the Guidelines
Lipoma excision on the anterior chest can be safely performed in an office setting for most patients, as long as proper precautions and guidelines are followed, including the use of local anesthesia and careful patient selection. The procedure typically involves local anesthesia using lidocaine 1-2% with epinephrine (1:100,000), injected around the lipoma to numb the area and reduce bleeding, with a maximum safe dose of 7 mg/kg of lidocaine with epinephrine, as recommended by manufacturer guidelines and supported by expert opinion 1.
Key Considerations
- Patients should expect the procedure to take 30-60 minutes depending on the lipoma size.
- Complications are rare but can include infection, bleeding, scarring, or recurrence.
- To ensure safety, patients should disclose all medications (especially blood thinners), allergies, and medical conditions beforehand.
- After the procedure, patients should keep the wound clean and dry for 24-48 hours, then follow wound care instructions provided by their doctor.
- Pain is typically minimal and can be managed with acetaminophen or ibuprofen.
Precautions and Contraindications
- The anterior chest location is generally safe for office procedures because it provides good access and has few critical structures nearby, though caution is needed for very large lipomas or those near the sternum or axilla.
- Patients with suspected atypical lipomatous tumors (ALT) or well-differentiated liposarcoma (WDL) may require further evaluation, including MRI and molecular testing, to determine the best course of treatment 1.
- Patients should seek immediate attention if they experience severe pain, excessive bleeding, fever, or increasing redness after the procedure.
Surgical Approach
- The surgeon will make an incision directly over the lipoma, carefully dissect it from surrounding tissues, and remove it completely before closing with sutures.
- Marginal resections as a complete en bloc specimen, even if classified histopathologically as R1, can give excellent rates of long-term local control for ALTs 1.
From the Research
Safety Considerations for Lipoma Excision on the Anterior Chest in an Office Setting
- The safety of lipoma excision on the anterior chest in an office setting depends on various factors, including the size and location of the lipoma, as well as the surgeon's experience and familiarity with the anatomical location 2.
- Guidelines for safe in-office lipoma excision include obtaining a clear diagnosis prior to excision, ensuring familiarity with the anatomical location, deferring excision if the lipoma appears to be located in the subfascial plane, and aborting excision if the patient is at risk for local anesthetic toxicity or if symptoms of motor blockade develop 2.
- The use of tumescent local anesthesia can be effective for excising large lipomas in an outpatient setting, with judicious patient selection and careful monitoring of the patient's condition 3.
- Alternative techniques, such as combined liposuction and excision, or ultrasound-guided regional blockade, may also be considered for lipoma removal, depending on the individual case and the surgeon's expertise 4, 5.
Anatomical Location and Surgical Approach
- The anterior chest is a common location for lipomas, and surgical excision can be performed safely in an office setting if proper precautions are taken 2.
- The choice of surgical approach, such as a linear incision or a Z-incision, depends on the size and location of the lipoma, as well as the surgeon's preference and experience 6.
- A Z-incision design can provide a larger surgical field area and may be useful for removing large lipomas, especially in areas with limited access 6.
Potential Complications and Risks
- Potential complications of lipoma excision on the anterior chest include bleeding, hematoma, seroma, and nerve injury 2, 4, 6.
- The risk of complications can be minimized by careful patient selection, proper surgical technique, and close monitoring of the patient's condition during and after the procedure 2, 3, 5.