What are the surgical options for buffalo hump?

Surgical Options for Buffalo Hump

Liposuction and excisional lipectomy are the primary surgical options for buffalo hump (dorsocervical fat pad), with excisional lipectomy being preferred for fibrous buffalo humps due to better long-term outcomes and lower recurrence rates. 1, 2

Understanding Buffalo Hump

Buffalo hump (dorsocervical fat pad enlargement) commonly occurs in association with:

• Cushing syndrome 3
• HIV-associated lipodystrophy 3
• Long-term steroid therapy 3

Pre-Surgical Assessment

Before considering surgical intervention:

• Evaluate for underlying causes (Cushing syndrome, HIV status, steroid use) 3
• Screen for metabolic abnormalities (hypertension, hyperglycemia, dyslipidemia) 3
• Assess severity and composition of the buffalo hump (fat vs fibrous tissue) 2

Surgical Options

1. Liposuction

• Appropriate for predominantly fatty buffalo humps 1
• Techniques include:
  • Traditional suction-assisted lipoplasty (SAL) 2
  • Tumescent anesthesia with multi-port liposuction (TARD technique) 4
• Benefits:
  • Minimally invasive with smaller scars 4
  • Shorter recovery time 4
• Limitations:
  • Higher recurrence rates when used alone for fibrous buffalo humps 2
  • Less effective for dense fibrotic tissue 2

2. Excisional Lipectomy

• Preferred for fibrous buffalo humps 2
• Involves direct surgical removal of the hypertrophied fat pad 5
• Often combined with liposuction for optimal contouring of surrounding areas 2
• Benefits:
  • More effective for fibrous tissue 2
  • Lower recurrence rates (no recurrences reported in multiple studies with follow-up of 24-26 months) 5, 2
• Limitations:
  • More invasive with larger scars 2
  • Longer recovery period 2

3. Combined Approaches

• Excisional lipectomy with adjunctive liposuction for peripheral contouring 2
• TARD technique (Tumescent anesthesia, sharp cannula release, multi-port liposuction) for mild to moderate fibrofatty humps 4
  • Achieved favorable outcomes in 91.1% of cases 4
  • Minimal scarring and rapid recovery 4

Surgical Outcomes

• Patient satisfaction is generally high with both techniques 5, 2, 6
• Long-term efficacy:
  • Excisional lipectomy shows favorable long-term outcomes even in patients continuing antiretroviral therapy 6
  • No recurrences reported in multiple studies with follow-up of 24-26 months 5, 2

Potential Complications

• Seroma formation (most common complication) 2
• Wound dehiscence 2
• Transient numbness (26.7% with TARD technique, resolving within 6 months) 4
• Infection (rare) 4
• Hematoma (rare) 4

Special Considerations

• For HIV-associated buffalo hump:
  • Surgical correction remains effective despite continued antiretroviral therapy 6
  • Consider modification of antiretroviral regimen when possible 3
• For steroid-induced buffalo hump:
  • Consider gradual tapering of steroid dose when medically feasible 3
• For Cushing syndrome-related buffalo hump:
  • Primary treatment should focus on addressing the underlying cause of hypercortisolism 3

Surgical Decision Algorithm

1. Assess buffalo hump composition:

   • Predominantly fatty → Consider liposuction
   • Fibrous or mixed → Consider excisional lipectomy or combined approach

2. Consider severity:

   • Mild to moderate → TARD technique may be appropriate 4
   • Severe or highly fibrous → Excisional lipectomy preferred 2

3. Consider patient factors:

   • Concern about scarring → Favor minimally invasive approaches
   • Desire for definitive correction with lower recurrence risk → Favor excisional lipectomy 2