This is a unique surgical technique of removing lipomas on the shoulder area via the armpit using endoscopic keyhole surgery as devised by Plastic Surgeon, Jag Chana. The scar is small and concealed in the armpit. In fact even a lipoma on the upper back and upper chest can be removed using this approach. This is particularly appealing to women since it avoids scarring in prominent and visible areas when wearing more revealing clothing.
Lipomas are benign tumours composed of adipose (fat) tissue, commonly found beneath the skin. Although generally harmless, their presence can sometimes cause discomfort, pain, or cosmetic concerns, especially when located on prominent areas such as the shoulder. The removal of a lipoma from the shoulder is a routine surgical procedure, but on the shoulder area the main consideration is the risk of adverse scarring. The shoulder area is a high risk area for keloid scar formation which is a permanent raised purple scar. Also, due to the mobility of the shoulder joint the stretching of a scar is common giving rise to a wide scar which looks like a stretch mark. In order to over come these risks it is best to avoid a scar over the shoulder area which is where this unique approach has advantages.
Understanding Lipomas
A lipoma is a soft, slow-growing, non-cancerous lump that develops under the skin. Lipomas are comprised of fat cells and are usually encapsulated, making them distinct from surrounding tissues. They can vary in size from as small as a pea to several centimetres across, and while most lipomas are painless, some may cause discomfort if they press on nerves or grow in areas subject to frequent movement or friction, such as the shoulder.
Lipomas can occur anywhere on the body, but the shoulder is a common site due to the abundance of subcutaneous fat . While the exact cause of lipoma formation remains unclear it is likely to be a spontaneous form of benign tumour. In some rare cases there may be a genetic tendency.
Symptoms and Diagnosis
The most obvious symptom of a shoulder lipoma is the presence of a soft, mobile lump beneath the skin. Lipomas are typically painless, but on rare occasions, they can induce discomfort if they grow large enough to compress adjacent structures. The overlying skin usually appears normal, and the lump can often be moved slightly under gentle pressure.
Diagnosis is generally clinical, based on history and physical examination. However, imaging studies may be warranted to confirm the nature of the lump, particularly if it is unusually large, deep, or exhibits atypical features. Ultrasound is commonly used to assess the size, depth, and consistency of the lipoma, while MRI scans may be considered for larger or suspicious masses to rule out malignancy or involvement of deeper tissues.
Indications for Lipoma Removal
Although most shoulder lipomas are harmless there are several reasons why removal might be considered:
• Persistent pain or discomfort due to the location or size of the lipoma.
• Restriction of shoulder movement or interference with daily activities.
• Cosmetic concerns, especially if the lipoma is large or noticeable.
• Rapid growth or change in characteristics, which may raise concerns about malignancy.
• Pressure on nerves or blood vessels leading to additional symptoms.
• Difficulty in diagnosing the lump as benign based on clinical and imaging findings alone.
Ultimately, a lipoma will continue to grow over years and the decision to remove a lipoma will depend on weighing the risks and benefits of surgery against the symptoms and concerns presented by the patient.
Indications for Lipoma Removal
Although most shoulder lipomas are harmless there are several reasons why removal might be considered:
• Persistent pain or discomfort due to the location or size of the lipoma.
• Restriction of shoulder movement or interference with daily activities.
• Cosmetic concerns, especially if the lipoma is large or noticeable.
• Rapid growth or change in characteristics, which may raise concerns about malignancy.
• Pressure on nerves or blood vessels leading to additional symptoms.
• Difficulty in diagnosing the lump as benign based on clinical and imaging findings alone.
Ultimately, a lipoma will continue to grow over years and the decision to remove a lipoma will depend on weighing the risks and benefits of surgery against the symptoms and concerns presented by the patient.
The most common Surgical Technique for Lipoma Removal
The standard approach to lipoma removal involves excision, which is the surgical removal of the entire lipoma along with its capsule. This is important to minimise the risk of recurrence. The procedure typically proceeds as follows:
1. Anaesthesia: Local anaesthetic is injected around the site to numb the area. For larger or more complex lipomas, sedation or general anaesthesia may be used.
2. Incision: An incision is made directly over the lipoma, taking care to position the cut in a way that minimises scarring and follows the natural lines of the skin.
3. Exposure and Dissection: The lipoma is carefully separated from surrounding tissues using blunt and sharp dissection. Care is taken to avoid damage to nerves, blood vessels, and muscles in the shoulder region.
4. Removal: The entire lipoma, including its capsule, is gently lifted out. The capsule is important, as incomplete removal may lead to recurrence.
5. Closure: The wound is closed with sutures, and a sterile dressing is applied. Dissolvable stitches may be used for deeper layers, while surface stitches are usually removed after 7–10 days.
In some cases, particularly for very large or deep lipomas, minimally invasive techniques such as liposuction may be considered. However, liposuction is less effective at removing the entire capsule and there is an increased the risk of recurrence since liposuction will leave small remnants of lipoma tissue behind.
Endoscopic technique of lipoma removal on the shoulder
This technique uses a keyhole approach and avoids prominent scarring on the visible area of the shoulder.
1. Anaesthesia: For small lipoma an awake procedure under local anaesthetic with sedation is possible. For larger lesions a general anaesthetic is usually required.
2. Incision: An incision is made in the armpit so it is hidden. Using endoscopic instruments a tunnel under the skin is made to locate the lipoma .
3. Through this small incision the lipoma is dissected free from it surrounding tissue. Care is taken to avoid damage to nerves, blood vessels, and muscles in the shoulder region.
4. Removal : The entire lipoma is removed without leaving any tissue behind. A drain may be placed temporarily in the space where the lipoma was removed.
5. The small incision in the armpit is closed with dissolvable sutures and a compression dressing is applied. The drain is usually removed a few hours later.
Risks of lipoma removal
Lipoma removal is generally safe, but like all surgical procedures, it carries some risks. Potential complications include:
• Bleeding and haematoma formation at the surgical site.
• Infection, which may require antibiotics or further intervention.
• Scarring, which may be more pronounced depending on the size and location of the incision but where an endoscopic removal is used this scar is very small and concealed within the armpit.
• Nerve injury, particularly if the lipoma is located near major nerves in the shoulder.
• Recurrence, if the lipoma or its capsule is not completely removed.
• Seroma (fluid accumulation), which may require drainage.
• Delayed wound healing, especially in patients with underlying health conditions.
Most complications are rare and can be managed effectively with prompt medical attention.
Postoperative Care and Recovery
After lipoma removal the wound care involves a wound check and removal of dressings at 1 week. During this time excessive activity should be avoided especially with limited shoulder movements. The healing period is approximately 2 weeks. However, heavy upper limb exercises should be voided for approximately 4 weeks. The small scar in the armpit fades gradually over a few months but this is not a concern for most patients since this is a well concealed site
Outcomes and Prognosis
The prognosis following lipoma removal from the shoulder is excellent in the vast majority of cases. Recurrences are extremely rare and complications are rare. Most patients experience relief from symptoms and improved cosmetic appearance.
In cases where the lipoma was large or deep, patients may experience temporary stiffness or weakness in the shoulder, but these symptoms usually resolve with gentle exercise and physiotherapy.
One potential issue is when the lipoma is very large its removal may leave a slight depression in the skin. However, for most patients this is more acceptable than a visible and adverse scar.
Alternatives to Surgical Removal
For small, asymptomatic lipomas, watchful waiting is often appropriate, with regular monitoring for changes in size or symptoms. Liposuction may be considered for certain cases, but as mentioned earlier, it does not reliably remove the capsule and may lead to recurrence.
Patient Experience and Psychological Impact
The presence of a lipoma, especially in a visible area like the shoulder, can have psychological and social implications. Some patients may feel self-conscious or anxious about the appearance of the lump, while others may worry about its potential to become malignant.
Postoperative satisfaction is generally high, with most patients reporting improved self-esteem and comfort following removal. The risk of recurrence is low, and complications are uncommon, contributing to positive outcomes for the majority of individuals.
Frequently Asked Questions
1. Is lipoma removal painful?
The procedure is typically performed under local anaesthesia, so pain during surgery is minimal. Some discomfort may be experienced after the anaesthetic wears off, but this is usually manageable with over-the-counter pain relief.
2. How long does it take to recover?
Most patients recover within two to three weeks, although complete healing may take longer for larger or deeper lipomas of up to 4 weeks.
3. Will the lipoma come back?
Recurrence is rare when the entire lipoma and its capsule are removed. However, new lipomas may develop elsewhere on the body, especially in individuals prone to their formation.
4. Are there any long-term effects?
Most patients experience no long-term complications. Scarring may occur, but usually fades over time. Rarely, nerve injury or persistent pain may occur.
5. Can lipomas turn cancerous?
Lipomas are benign and do not become cancerous. However, rapid growth or changes in characteristics should be evaluated to rule out other conditions.
Conclusion
An endoscopic Lipoma removal on the shoulder is a safe and effective procedure for alleviating symptoms, improving cosmetic appearance, and providing peace of mind for patients. The risks are minimal and outcomes are excellent.
Consultant Plastic Surgeon , Jag Chana is highly experienced in endoscopic Plastic Surgery and also offers endoscopic forehead ad facial lipoma and osteoma removal.
For more information or to book a Consultation please contact via the email or telephone number on this website