This 32-year-old man had a very large giant lipoma, present for years. After MRI to confirm it was a benign lipoma, the Lowen technique was used to remove it under local anesthesia in the office operating room, thus avoiding a long incision and general anesthesia.

For this patient, as for many others, the lipoma had not been removed when it was much smaller because of the patient’s concern about a long scar, and for some, the fear of general anesthesia.

After local anesthesia by direct infiltration of xylocaine and epinephrine into and under the lipoma, then waiting 30 minutes for vasoconstriction to ensure there is no bleeding, the lipoma was separated from surrounding tissue over its entire anterior surface, using dissecting scissors. It was then debulked with power-assisted liposuction, using a fine cannula to preserve its structure. Liposuction is not intended to remove the lipoma, but to change it to a soft, malleable structure, that similar to an octopus, can go through a small opening. Removal is done by careful traction and release of attachments with dissecting scissors. There is always a vascular pedicle on the bottom, which is the blood supply to the lipoma. This is carefully looked for and suture ligated to prevent bleeding. The pocket is irrigated and inspected under magnification and fiberoptic headlight illumination, and complete removal is confirmed. There is a distinct lining interface between normal subcutaneous fat and the space that was occupied by the lipoma, which has its own thin capsule, so it can be definitely determined that all of the lipoma has been removed.

The cavity is partly closed internally with absorbable sutures, a drain is placed for a week, and the patient can resume normal, non-athletic activities immediately. A membrane dressing covers the incision and drain, so the patient using can shower normally.

This giant lipoma, because it was so wide, was removed using two small incisions . Normally one is used.