Synonyms in a broader sense
adipose tissue tumor, fat, tumor, skin, adipose tissue tumor
Causes
There is currently no confirmed cause. As with most tumors, a genetically determined degeneration of certain cells – in this case fat cells (adipocytes) – is assumed. These fat cells seem to multiply and form a node.
In some of the patients, a change on chromosome 12 can be detected, which also suggests an inherited component. It is possible that stem cells, which normally develop into stem cells, are also responsible for the formation of the lipoma. Furthermore, various other diseases could play a role in the formation of the lipoma.
In particular, diabetes and lipid metabolism disorders (e.g. hyperlipidemia) are suspected to promote the development of lipoma. However, such relationships have not been sufficiently investigated. It is also suspected that strong impacts or bruises can lead to the development of a lipoma.
On the other hand, obesity can be excluded as the cause. Thin persons have a lipoma just as often as overweight persons. In certain genetic diseases, lipoma occurs in multiple forms, i.e. the patient has many lipomas at the same time. Examples are the lipomatosis dolorosa (Dercum disease).
SymptomsComplaints
A benign lipoma usually causes no symptoms, so that it is often only discovered when the lipoma has reached a certain size. They are conspicuous as soon as they can be palpated or seen. The lipoma is painless.
The only time they can cause pain is when they are located in an unfavorable place – for example, near nerves – and press on them. See: Pain with a lipoma In their consistency they are either soft or also prallelastic and lie directly under the skin. The nodes can be moved back and forth under the skin. The benignity of the tumor (lipoma) is based on this mobility.
Localization by body region
The back is one of the most common localizations of lipoma. The lipoma is rather at an unproblematic location on the back, since little can happen there. If the lipoma is touched, palpation findings can range from very soft to very hard.
However, in most cases it is soft and easily movable. In the case of a rough, hard palpation, it should be clarified whether it is a lipoma or a liposarcoma, since the latter also feels hard. The size of the lipoma on the back can vary greatly, ranging from lens-sized and hardly palpable to fist-sized and clearly visible and palpable.
On the back, the lipoma usually causes no complaints. Above a certain size, however, it can be perceived as unaesthetic. From a certain size onwards, friction and a feeling of pressure can occur on a purely physical level.
In addition, due to its size, the lipoma on the back can press on nerves lying next to or below it. This can lead to sensory disturbances or numbness in the skin area. Pain can also be caused by irritation of nerves or pressure on tendons and muscles.
If one has a lipoma on the spine and such discomfort occurs or the lipoma is perceived as an aesthetic strain, then removal is recommended. This is uncomplicated and can be carried out easily, especially on the back. The removal of the lipoma can be done by the family doctor or a surgeon in private practice or in hospital.
As a rule, a local anesthetic is used, i.e. an anesthetic of the affected area. Then the lipoma is cut out. Since it is usually well encapsulated, this is a successful procedure.
However, a scar may remain, and a dent may form in the further course of the operation due to the removal of a lot of tissue (in the case of a large lipoma). You can prevent the formation of a dent using various techniques, but this is not always successful. In case of a very large lipoma or if the location is unfavorable, surgery under general anesthesia may be considered.
In some cases, the scar resulting from a lipoma operation on the back can be more visually striking than the removed lipoma. As with any operation, surgical removal of the lipoma on the back also involves certain risks and side effects. For example, the anesthetic may have side effects, and there is also the risk that an infection of the wound may occur during any operation, even if hygiene and disinfection measures are observed.Especially on the back, where the lipoma can become quite large without causing problems early on, the lipoma can also be removed by the method of liposuction.
With this procedure, there is significantly less scarring because only small tubes have to be inserted through the skin and no large incision is made. In addition, the suction is regulated in such a way that there are usually no dents. However, the complete removal of the lipoma by suction is difficult, because usually not all cells can be reached.
New lipomas are very likely to grow from the remaining cells, so the probability of relapse is greatly increased. Slim women and women with smaller breasts may discover the lipomas themselves. They present themselves as rather soft structures and originate from the adipocytes (fat tissue cells).
Lipomas sometimes grow very slowly and it can take several years before they reach their final size. The diameter can become so large that the lipoma appears as a bulge under the skin. Lipomas in the breast do not pose an increased risk of cancer.
However, if a soft mass is noticeable, a medical examination should follow. An experienced physician can already make an initial determination as to whether it is a lipoma by means of ultrasound and palpation or mammography. However, since it is not possible to make a complete diagnosis from the outside, a biopsy of the breast is advisable to exclude possible malignant degeneration.
In women over 50 years of age, further clarification is urgently indicated to exclude malignant degeneration, because in this group of women after menopause, lipoma is one of the most frequent new formations. Lipomas develop in the fatty tissue under the skin on the breast or partly also in the glandular body. In combination with connective tissue cells they are called fibrolipomas and in combination with glandular cells they are called adenolipomas.
Lipomas often regress over a few years. Nevertheless, gynecological monitoring should be carried out to detect possible changes that indicate a prognostically unfavorable course and to intervene if necessary. If the lipomas grow to a size that is uncomfortable for the patient, surgical removal can be performed.
Also for safety reasons, a resection should then be performed. Lipomas on the thigh are one of the more frequent locations together with the head, neck, back and trunk. If they occur on the lower extremity, however, they are usually located deeper – i.e. not in the superficial layers of the skin.
There are so-called infiltrating lipomas. These are lipomas that are found intra- or intermuscularly (inside a muscle or between different muscles). Lipomas on the thigh are rather unproblematic.
However, when they reach a certain size, paresthesias can occur. This is caused by an unfavorable position where the lipoma presses on a nerve. The removal of a lipoma on the thigh is, if it has to be performed, an uncomplicated procedure.
Since there is fatty tissue on the neck, a lipoma can also develop here. Unfortunately, there is not much room for a spreading tumor on the neck, so structures that are located in the immediate vicinity are quickly affected. A possible complication is, for example, pressure on the carotid artery in the neck.
In addition, the muscles in the neck can be restricted in their mobility or pain can be caused by pressure on nerves running there. Since these symptoms occur more often in the neck than in the back, due to the anatomical conditions, lipomas are removed more frequently. Surgical removal of lipomas involves more risks in the neck and cervical area, since many sensitive structures are located in a confined space.
Complications are therefore nerve damage, which can lead to sensory disturbances, for example. Patients usually do not notice lipomas in the head area until they are already a certain size, since the “lumps” are not noticeable before simply because of their small size. Of all body regions, lipomas occur most frequently in the head region.
They can be found at various locations in the head and neck area. They can be found subcutaneously, i.e. directly under the skin, or under the muscle fascia, i.e. they lie within the connective tissue capsule surrounding the muscles.
Common sites are subcutaneous lipomas in the neck and subfascial lipomas in the transition from forehead to hair. (The diagnosis of lipoma is usually made by palpation and assessment of the tumor’s mobility. (Tumor means in this context and also otherwise – simply swelling).
An exact diagnosis is usually ensured by puncture. The exact size is determined by ultrasound. Here the fatty tissue can also be distinguished from other changes. Fatty tissue appears whitish in sonography (ultrasound), while cysts would appear black or dark. A cyst is a cavity filled with fluid.
