Which specialist should I consult for lipoma removal?

Lipoma Removal: Specialist Selection

For lipoma removal, you should consult with a surgeon specifically trained in soft tissue tumor treatment, such as a general surgeon, plastic surgeon, or surgical oncologist depending on the lipoma's size, location, and complexity. 1

Specialist Selection Based on Lipoma Characteristics

• For standard subcutaneous lipomas (most common presentation), a general surgeon or dermatologic surgeon with experience in soft tissue procedures is appropriate 1
• For large (>5 cm), deep, or complex lipomas, seek a surgical oncologist or specialist surgeon with specific training in soft tissue tumors 1
• For lipomas in cosmetically sensitive areas (face, neck), consider a plastic surgeon who can minimize scarring while ensuring complete removal 2, 3

Pre-Removal Assessment

• Initial evaluation should include ultrasound as an effective triage tool to confirm the lipomatous nature of the mass 4
• For larger (>5 cm), deep-seated, or atypical lipomas, MRI with expert review is recommended to differentiate between benign lipomas and atypical lipomatous tumors (ALT) 5, 6
• Red flags requiring specialist referral include:
  • Rapid growth
  • Pain not associated with trauma
  • Size >5 cm
  • Deep location
  • Concerning features on imaging 4

Treatment Approaches

• Complete surgical excision is the standard treatment for symptomatic lipomas 1
• For smaller lipomas, minimally invasive techniques may be used:
  • The "2.5-cm method" allows removal of even large lipomas through a small incision 2
  • Tumescent local anesthesia can facilitate outpatient removal of large lipomas (up to 22 cm) 7
  • Minimal-scar segmental extraction offers excellent cosmetic results with low recurrence rates (0.8%) 3
• For multiple or large lipomas, liposuction techniques may be considered as an alternative to traditional excision 8

Post-Treatment Considerations

• After surgical excision and postoperative wound care, patients can typically be discharged to primary care 6, 4
• Re-referral is only necessary if there is clinical suspicion of recurrence 6
• Recurrence rates for properly excised lipomas are generally low 4, 3

Important Caveats

• Lipomas should be removed by surgeons with specific training in soft tissue tumor treatment to ensure complete removal and minimize recurrence 1
• While general practitioners may remove small, superficial lipomas, referral to specialists is recommended for larger, deeper, or atypical lesions 1, 4
• For any lipoma with concerning features (rapid growth, pain, large size), evaluation by a surgical oncologist is warranted to rule out malignancy 5, 6