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Research Letter |

Minimal Incision Extraction of Lipomas FREE

Michael T. Cosulich, MD1; Matthew A. Molenda, MD2; Eliot Mostow, MD, MPH3; Ashish C. Bhatia, MD4; Robert T. Brodell, MD5,6
[+] Author Affiliations
1Department of Dermatology, Georgetown University School of Medicine, Washington, DC
2Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, Ohio
3Department of Dermatology, Northeastern Ohio Medical University, Rootstown
4Department of Clinical Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
5Department of Dermatology, University of Mississippi Medical Center, Jackson
6Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, New York
JAMA Dermatol. 2014;150(12):1360-1361. doi:10.1001/jamadermatol.2014.3234.
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Published online

Lipomas are benign proliferations of mature fat that are occasionally tender. Common treatment approaches include elliptical excision, liposuction, and injection lipolysis. For most lipomas, we favor the minimal incision or “squeeze” technique, whereby lipomas are expressed through a small scalpel or punch incision.1,2 To our knowledge, the utilization rate of this simple, effective technique has not been previously studied.

A survey was distributed to all 233 members of the Ohio Dermatological Association to determine if they treat lipomas. The preferred technique in several clinical scenarios was queried (1-cm lipoma, 3-cm lipoma, and multiple painful 1-cm lipomas). Treatment choices included elliptical excision, linear incision extraction (incision length, 100% diameter of lipoma), minimal incision extraction (MIE; incision length, 25%-50% of lipoma), referral, or “other technique.” Years in practice and practice focus were recorded (medical, surgical, or cosmetic). Statistical analysis used the Fisher exact and McNemar tests. This study was approved by the institutional review board of Northeastern Ohio Medical University.

There were 87 total respondents (37% response rate). The survey results are summarized in the Table. The lone response for other technique was liposuction. Dermatologists who choose not to treat lipomas most commonly responded that they were “uncomfortable with this procedure.” Practice type and years of experience did not affect the results significantly.

Table Graphic Jump LocationTable.  Treatment Type by Clinical Situation

Minimal incision extraction has been adopted by many dermatologists because it is an office procedure with minimal complications, a specimen is produced to confirm the lesion’s benign nature, and lipomas are slow growing and unlikely to recur quickly, even if not completely removed. Minimal incision extraction is favored compared with elliptical excision because it is quick, easily and safely performed in the office setting, and allows removal during a standard visit rather than rescheduling patients for a more time-consuming elliptical excision. Lipoma extraction through MIE is particularly easy and practical in patients with multiple painful lipomas. Our survey revealed a significant difference between the rate of dermatologist use of MIE for 1-cm and 3-cm lipomas (67.8% vs 55.2%; P = .04), suggesting that practitioners find removing larger lipomas more difficult with this technique. Certainly, larger lipomas may require dissection, piecemeal removal, or more hemostasis, and are more time consuming, but MIE is still possible and more efficient than elliptical excisions in most cases.2 We have used MIE on lipomas of up to 14 cm. Limitations of this study include a geographically limited study population and the lack of data to discern whether respondents would choose different techniques based on body location.

The survey data demonstrate that approximately 33% of dermatologists do not use MIE, even for solitary 1-cm lipomas, and that the most commonly cited reason for not treating lipomas was being uncomfortable with this procedure. Perhaps after seeing a demonstration (Video) of this quick and simple technique, more dermatologists will be willing to attempt MIE. Other physicians may be waiting for more outcome data demonstrating the recurrence rate after MIE vs elliptical excisions. One case series using MIE had a recurrence rate of 1.4%, but this source did not disclose the follow-up period or provide comparative data.3 Our clinical experience with this procedure suggests that the recurrence risk after MIE is low, and when recurrences occur, they can be treated with the same MIE technique, avoiding the need for an elliptical excision.

Video.

Minimal Incision Extraction Demonstration

This .mp4 video briefly demonstrates the minimal incision extraction technique for lipomas.

Accepted for Publication: August 22, 2014.

Corresponding Author: Robert T. Brodell, MD, Department of Dermatology, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216 (rbrodell@umc.edu).

Published Online: October 22, 2014. doi:10.1001/jamadermatol.2014.3234.

Author Contributions: Drs Cosulich and Brodell had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Cosulich.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Cosulich, Molenda.

Critical revision of the manuscript for important intellectual content: Mostow, Bhatia, Brodell.

Statistical analysis: Cosulich.

Administrative, technical, or material support: Molenda, Mostow, Bhatia, Brodell.

Study supervision: Bhatia.

Conflict of Interest Disclosures: Dr Brodell reports having received honoraria from presentations for Allergan, Galderma, 3M/Graceway Pharmaceuticals, GlaxoSmithKline/Stiefel, Dermik/BenzaClin Speaker Bureau, Novartis Pharmaceuticals Corporation, sanofi-aventis, Medicis Speaker’s Bureau, PharmaDerm (a division of Nycomed US Inc), and Veregen Speakers Bureau; receiving consultant fees from Galderma Laboratories, LP, Medicis, Dow Pharmaceuticals Sciences, and Promius Pharma; serving on the advisory boards of Dow Pharmaceuticals Sciences and Nycomed US Inc; and performing clinical trials for Genentech, Galderma, Abbott Laboratories, and Dow Pharmaceuticals Science. Dr Molenda reports having partial ownership rights in projects being developed by Cleveland Clinic Innovations and receiving consulting funds from Memorial Sloan Kettering Cancer Hospital. Dr Mostow reports receiving grants for clinical trials research from HealthPoint and speakers fees from HealthPoint and Ranbaxy Laboratories. No other disclosures were reported.

Powell  B, McLean  NR.  The treatment of lipomas by the “squeeze” technique. J R Coll Surg Edinb. 1985;30(6):391-392.
PubMed
Christenson  L, Patterson  J, Davis  D.  Surgical pearl: use of the cutaneous punch for the removal of lipomas. J Am Acad Dermatol. 2000;42(4):675-676.
PubMed   |  Link to Article
Rao  SS, Davison  SP.  Gone in 30 seconds: a quick and simple technique for subcutaneous lipoma removal. Plast Reconstr Surg. 2012;130(1):236e-238e.
PubMed   |  Link to Article

Figures

Tables

Table Graphic Jump LocationTable.  Treatment Type by Clinical Situation

References

Powell  B, McLean  NR.  The treatment of lipomas by the “squeeze” technique. J R Coll Surg Edinb. 1985;30(6):391-392.
PubMed
Christenson  L, Patterson  J, Davis  D.  Surgical pearl: use of the cutaneous punch for the removal of lipomas. J Am Acad Dermatol. 2000;42(4):675-676.
PubMed   |  Link to Article
Rao  SS, Davison  SP.  Gone in 30 seconds: a quick and simple technique for subcutaneous lipoma removal. Plast Reconstr Surg. 2012;130(1):236e-238e.
PubMed   |  Link to Article

Correspondence

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Submit a Comment
Modification to Short Incision Method for Lipomas.
Posted on October 23, 2014
Philip S Bekhor
Director Laser Unit Dept. Dermatology RCH Melbourne Australia
Conflict of Interest: None Declared

This paper makes an excellent contribution in familiarizing dermatologists with very effective and less invasive methods to treat smaller lipomas. A subtle improvement to the presented method is to use a short stab incision just large enough to allow the entry of a small curette. The curette and/or artery forceps are then introduced to break up the lipoma. The lipoma can then be expressed one lobule at a time using the instruments like a shoe horn. The advantage is a less conspicuous scar, and, because no skin has been removed, the scar is less likely to spread or produce "dog ears." Suturing of this slit incision is entirely optional.

A Response to “Minimal Incision Extraction of Lipomas”
Posted on January 6, 2015
Kraig K. Jenson MD, Byron C. Edwards PA-C PhD, Devin M. Burr MS IV
Dermatology Center. Western University of Health Sciences
Conflict of Interest: None Declared

Case Report A 34-year-old male presented a growing and painful lipoma that was 15 cm in diameter. The lipoma had been growing on his back for five years. We performed a one-inch incision in the center of lipoma, and we were able to remove the lipoma with dissection and piecewise removal. To prevent fluid filling, we inserted a Jackson-Pratt Drain, performed a three-layered suture closure, and applied a pressure dressing. The dressing was removed in our office on post-op day number two with 60 CC of serum collection. The following day, we removed the drain totaling the serum to 70 CC over the three days. Discussion: We have used MIE on lipomas for many years and have been pleased with the results. Our clinical experience has shown that patient satisfaction has been high from low recurrence rate, quick recovery, and low morbidity. We find the procedure simple. Typically, lipomas will express easily with gentle squeezing, but in more difficult cases or with larger lipomas, the lipoma can be freed from the tissue using scissors or blunt dissection. MIE is more time consuming than performing elliptical excisions, but we believe that patients appreciate the decrease in scar size compared to the longevity of the procedure. We typically do not use closed-system drains like the Jackson-Pratt Drain mentioned above, except in cases of larger lipomas where the risk of hematoma or seroma is higher. In support of Dr. Cosulich and his colleagues, we find using minimal incision extraction for the removal of lipomas both effective and cosmetically satisfying for patients. Their study was directed towards smaller lipomas, but as they reported, MIE is an effective treatment option for larger lipomas. We express our gratitude for their study and agree with their findings. Resources1. Cosulich MT, Molenda MA, Mostow E, Bhatia AC, Brodell RT. Minimal Incision Extraction of Lipomas. JAMA Dermatol.2014;150(12):1360-1361. doi:10.1001/jamadermatol.2014.3234.

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Video.

Minimal Incision Extraction Demonstration

This .mp4 video briefly demonstrates the minimal incision extraction technique for lipomas.

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