Lipomatosis

What is lipomatosis?

Lipomatosis is a systemic condition of soft tissues, characterized by the deposits of excess adipose tissue, encapsulated or well delimited, within subcutaneous symmetrical liposomes present on the neck, arms, or trunk. Lipomatosis is a common and benign problem among adults (30-70 year old, mainly in the Mediterranean climate). The causes of symmetrical or diffuse lipomatosis, with multiple lipomas located in different areas of the body, revolve around genetics, as it’s either an autosomal dominant transmitted condition (if one of the parents has the genetic mutation, they are 50% more likely to pass it on to their children) or a mitochondrial transmitted (through mitochondrial DNA from mother to child) condition. Multiple modified genes have been discovered in families with lipomatosis, genes that determine functionality of the lipid metabolism and excess deposits (MT-TK genes, IC isoprotein on chromosome 12, PTEN genes). The non-genetic causes of lipomas can also be: alcohol consumption, large variations in weight with immediate and forced weight loss, steroid injections, metabolic disorders.

What risks does the presence of one or more lipomas entails?

The signs and symptoms of a lipoma (or diffuse lipomatosis) vary from person to person. There are cases where there is accelerated lipoma growth, where the size increases in a matter of months, while in other cases it takes years. Depending on their size they can create an aesthetically displeasing appearance or deformity of the silhouette and limbs or they can functionally injure through: pain or loss of sensitivity through nerve compression, inability to move the neck, peripheral neuropathy, if it develops in the medullary canal, neurological disorders, sleep apnea or other sleep disorders, hypertension, diabetes, and even thyroid or liver disease, if it accumulates in the internal organs. Lipomas are usually benign; however, there are extraordinary cases in which these can develop, over time, into malignant tumors.

Tips before surgery:

The usual preoperative tests will be performed: EKG, hemolysogram, biochemistry and coagulation tests, and if you have other problems, additional specialized consultations (cardiology, neurology, etc.), and for an in-depth view of lipomatosis you can additionally have an ultrasound of soft tissues (with or without Doppler ultrasound). Adequate local hygiene is required, along with hair removal in the area with lipomatosis (except for the scalp) and depending on the size of the liposomes and their number, the patient will take leave for both the day of the surgery and several days postoperatively.

How do we treat lipomas / lipomatosis?

liposuction coupled with abstinence from alcohol consumption and following a drug treatment for metabolic disorders. The risk of recurrence is higher in liposuction, where the entire lipoma cannot be removed, but the scar is punctiform (at the place of insertion of the cannula). surgically, by incision, to carefully dissect and excise the lipomas and adherent capsule, while preserving and relieving the existing nerves or vascular structures among which they have developed, and, if needed, to excise excess teguments (caused by slow tumor growth).  The incision will be closed through either direct suture or skin flaps. Postoperative recovery varies depending on the size of the liposomes, their location and the type of anesthesia performed (local, intravenous, general, etc.).