Lipoma

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A lipoma is a benign lump of fat under the skin. It is soft, moves under the finger and grows over years. Removal takes 30 to 45 minutes under local anaesthetic, leaves a line about the width of the lump, and the tissue goes to a laboratory. Removal is £695.

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When to get help today

  • A lump growing quickly over weeks rather than years
  • A lump larger than 5cm, or one that is deep and firm rather than soft
  • Pain in the lump at rest or at night
  • A lump that is fixed to the skin or to the muscle beneath it
  • A lump that has become hot, red and tender

Any of these needs to be seen the same day. If you are severely unwell, go to your nearest emergency department or call 999.

What lipoma is

A lipoma is a collection of mature fat cells inside a thin capsule, sitting between the skin and the muscle. It feels soft, doughy and slightly mobile, and it is the commonest soft tissue lump adults get. Most sit on the shoulders, back, neck, arms or thighs.American Family Physician Salam, 2002

They are benign. A lipoma does not turn into a cancer. The reason a doctor examines one properly is that a small number of lumps that feel like a lipoma are not one, and the features that separate them are size, depth, growth rate and pain.NICE NG12, 2015

Signs and causes

A typical lipoma is under 5cm, soft, painless, and has been there for years. It slides under the skin when you press one edge. Some people get several, and about 1 in 5 have a family member with them too.American Family Physician Salam, 2002

The referral threshold that matters is a soft tissue lump that is growing, is over 5cm, is deep to the muscle fascia, or is painful. Any of those means an ultrasound or an urgent specialist opinion rather than a removal, because a soft tissue sarcoma can present as a painless lump.NICE NG12, 2015

Send us what you are seeing and we will tell you what it is likely to be.

How it is diagnosed

Most lipomas are diagnosed by feel. The doctor measures it, checks whether it moves freely, presses to see whether it is tender, and asks how long it has been there and how fast it has changed. That examination takes about 5 minutes and settles the question in most cases.American Family Physician Salam, 2002

An ultrasound is arranged where the lump is over 5cm, deep, fixed or growing, and sonography identifies a typical lipoma reliably enough to settle most of those. Every lipoma removed here is sent for histology whether or not it looked typical, because the report is what turns a clinical opinion into a diagnosis.Radiology Inampudi, 2004

What can be done about it

  • Leaving it alone

    The right answer for most. A small painless lipoma that has not changed in years does not need removing and there is no medical reason to.

  • Ultrasound first

    For a lump over 5cm, one that is deep, or one that has grown, imaging comes before any decision about removing it. Ultrasound is the first test rather than MRI.Royal College of Radiologists iRefer 8th edition, 2017

  • Liposuction of the lipoma

    Leaves a smaller mark but leaves the capsule behind, so the lump comes back more often. It also produces no intact specimen for the laboratory.American Family Physician Salam, 2002

  • Excision with the capsule

    The lipoma and its capsule lifted out whole through a line over the lump, closed with stitches, in one visit under local anaesthetic. Recurrence after complete excision is uncommon. You are told the length of the line and the price before you agree to it.General Medical Council GMC guidance, 2020

What to expect

Removal takes 30 to 45 minutes for a typical lipoma. Stitches come out at 10 to 14 days. Expect a firm ridge under the scar for 6 to 8 weeks, which is healing tissue rather than a recurrence, and a line that fades over 6 to 12 months.Plastic and Reconstructive Surgery Mustoe, 2002

Bruising is common and settles in 2 weeks. Wound infection is uncommon after clean minor surgery and antibiotics are not given routinely to prevent it.NICE NG125, 2020

What you can do before you come

Measure the lump across its widest point with a tape and write the date beside the number. Do it again in 4 weeks. A lump that has not changed in size over a month is behaving like a lipoma, and that measurement is worth more to the doctor than a description.

Three questions decide the pathway, and you can answer all three before you arrive. How long has it been there, has it grown in the last 6 months, and does it hurt when nothing is touching it. Growth or pain moves you to imaging rather than removal.NICE NG12, 2015

What not to buy

Do not pay for an MRI on a small, soft, mobile lump that has been the same size for years. Ultrasound answers the question in the cases where imaging is needed at all, and most lipomas need none.NICE NG12, 2015

Do not have a lipoma removed by a method that leaves the capsule if you want it gone for good. A smaller scar today is a second procedure later.American Family Physician Salam, 2002

What we would do

Step 1

The lump is examined

Measured, moved and timed against your history. You are told whether it behaves like a lipoma and whether imaging comes first.

Step 2

The plan and the price, before anything

Where it will be cut, how long the line will be, what the recovery is, and what it costs. Nothing happens until you agree to it.

Step 3

Out in one visit, and the report follows

Removed with its capsule under local anaesthetic. A laboratory reads the specimen and your result comes back from the same doctor who took it out.

Ask before you book if you are not sure this is the right appointment.

Questions people ask

No. A lipoma is benign and does not become cancerous. The reason to have one examined is that a small number of lumps that feel similar are not lipomas, and size over 5cm, depth, rapid growth or pain are the features that separate them.

Removal is £695, which includes the consultation, the local anaesthetic, the procedure, the histology report and the aftercare. A 30 minute consultation on its own, if you only want it examined, is £150.

Rarely, when the whole capsule is taken. Recurrence is more common after methods that break the lipoma up and leave the lining behind, which is why it is removed intact here.

The line is usually a little shorter than the width of the lump, because the fat delivers through a smaller opening than its diameter. It is red and firm for about 8 weeks and then fades over 6 to 12 months.

Often, yes, if they are small and in reachable areas. The doctor will say at the consultation how many can be done safely in one sitting and what that costs before you decide.

Most people do not. An ultrasound is arranged where the lump is over 5cm, sits deep to the muscle layer, has grown in the last 6 months, or hurts at rest.

Desk work, yes, and most people go straight back to it. Avoid heavy lifting, gym work and anything that stretches the skin over the wound until the stitches come out at 10 to 14 days. Keep the dressing dry for the first 48 hours and shower normally after that.

How to reach us

This page is general information about a condition and it is not a diagnosis. Treatment depends on what a doctor finds when they examine you, and no outcome is guaranteed. If you are severely unwell, or if any of the warnings at the top of this page apply to you, go to your nearest emergency department or call 999.

References

Written by the clinical team at The Wellness. Awaiting clinical sign off.

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