How is a buffalo hump (dorsocervical fat pad) treated?

Treatment of Buffalo Hump (Dorsocervical Fat Pad)

Surgical intervention, particularly excisional lipectomy, is the most effective treatment for buffalo hump with long-term favorable outcomes in patients experiencing significant physical or psychological discomfort. 1

Understanding Buffalo Hump

Buffalo hump (dorsocervical fat pad) is a condition characterized by fat accumulation in the upper back and neck area. It can occur in several contexts:

• As a side effect of long-term steroid therapy 2
• As part of Cushing syndrome 2
• As a component of HIV-associated lipodystrophy syndrome, particularly in patients on antiretroviral therapy 2, 3
• As a feature of metabolic disorders

Diagnostic Considerations

Before initiating treatment, it's important to identify the underlying cause:

• Steroid-induced: Review medication history for long-term corticosteroid use
• Cushing syndrome: Look for other signs like central obesity, moon face, hirsutism, and hyperglycemia 2
• HIV-associated lipodystrophy: Often accompanied by peripheral fat wasting and central fat accumulation 4
• Metabolic disorders: Check for insulin resistance, diabetes, and dyslipidemia

Treatment Options

1. Address Underlying Cause (When Possible)

• Steroid-induced: Consider steroid dose reduction or alternative therapy if clinically appropriate 2
• Cushing syndrome: Treat the underlying cause (e.g., adrenal tumor, pituitary tumor)
• HIV-associated lipodystrophy: Consider modification of antiretroviral regimen if possible, though this may not reverse existing changes 2

2. Surgical Interventions

Surgical approaches are the mainstay of treatment for established buffalo hump:

• Excisional Lipectomy: Most effective for fibrous buffalo hump tissue

  • Provides superior long-term outcomes compared to liposuction alone 1
  • Allows for complete removal of the fibrous fat pad
  • May be combined with suction-assisted lipoplasty (SAL) for optimal contouring of surrounding areas

• Liposuction:

  • May be used for less fibrous cases
  • Often has variable short-term and long-term results 5
  • Higher recurrence rate when used alone compared to excisional techniques

3. Post-Surgical Considerations

• Monitor for common complications:

  • Seroma formation (most common complication)
  • Wound dehiscence
  • Recurrence (less common with excisional techniques)

• Follow-up evaluations should include:

  • Clinical assessment of the surgical site
  • Evaluation for recurrence, especially if the underlying cause persists

Special Considerations for HIV Patients

For HIV patients with buffalo hump:

• Surgical treatment has shown long-term favorable effects even in patients continuing antiretroviral therapy 6
• The fibrous nature of HIV-associated buffalo hump makes excisional lipectomy particularly appropriate 1
• Consider the psychological impact of the deformity, which can significantly affect quality of life

When to Consider Surgical Intervention

Surgical treatment should be considered when:

1. The buffalo hump causes significant physical discomfort (neck pain, difficulty sleeping)
2. The deformity results in psychological distress
3. Conservative measures have failed
4. The patient is medically stable for surgery

Pitfalls and Caveats

• Recurrence is possible, especially if the underlying cause persists
• Surgical complications include seroma, hematoma, and wound healing issues
• In HIV patients, continued antiretroviral therapy may lead to recurrence, though this is less common with excisional techniques
• Addressing only the buffalo hump without managing the underlying condition may lead to suboptimal outcomes

In conclusion, while the etiology of buffalo hump is multifactorial, surgical management—particularly excisional lipectomy—offers the most definitive treatment for patients experiencing significant physical or psychological impact from this condition.