Lipomatosis is a condition that may not be widely known, but for those who experience it, it can be both physically and emotionally challenging. This blog post explores what lipomatosis is, why it occurs, how to identify it, and what treatment options are available.

Lipomas are generally not dangerous, but in large numbers or in sensitive areas, they may cause discomfort, cosmetic concerns, or functional issues.

The exact cause of lipomatosis isn’t fully understood, but several contributing factors have been identified:

• Genetic Predisposition: Multiple familial lipomatosis is an inherited condition in which several members of a family develop numerous lipomas. If a close relative has had multiple lipomas, your risk may be higher.
• Body Weight: Although lipomas are made of fat, there’s no direct link between being overweight and developing lipomatosis. Still, increased fat tissue might play a supporting role.
• Gender: While isolated lipomas are more common in women, lipomatosis tends to affect men more frequently.
• Age: Most cases develop between the ages of 40 and 60, although they can occasionally appear earlier.
• Alcohol Consumption: Chronic alcohol use has been linked with certain types of lipomatosis, especially multiple symmetrical lipomatosis.

Underlying Health Conditions: Diseases affecting the liver or issues related to blood sugar regulation may be linked to lipoma formation in some individuals.

There are several types of lipomatosis, based on where the lipomas appear and whether they cause additional symptoms:

• Congenital Infiltrative Lipomatosis of the Face: A rare type involving fatty tissue on the face from birth.
• Pelvic Lipomatosis: A rare condition where fat accumulates in the pelvic region.
• Encephalo Cutaneous Lipomatosis: A very rare neurocutaneous disorder involving lipomas on the scalp and central nervous system.
• Painful Lipomatosis (Adiposis Dolorosa): This form causes pain, swelling, and fatigue and is more common in overweight women, especially after menopause.

Multiple Symmetrical Lipomatosis (Madelung’s Disease): This condition, often seen in middle-aged men with a history of alcohol use, results in symmetrical fatty deposits around the neck, shoulders, and upper trunk.

The hallmark of lipomatosis is the presence of multiple fatty lumps in one area. These lumps are usually:

• Soft and rubbery
• Movable under the skin
• Painless (in most cases)

However, some individuals may experience:

• Mild pain or tenderness (especially after trauma or pressure)
• Swelling or inflammation if a lipoma becomes irritated
• Infection, which can cause redness, warmth, and an increase in size

Pain is more likely if lipomas press on nerves or if there are complications such as infection.

While lipomatosis can often be recognized based on physical examination alone, further assessment may be needed for diagnosis and treatment planning. These might include:

• Ultrasound: To determine the depth and extent of the lipomas.
• Tissue Biopsy or Histological Analysis: To rule out malignancy or confirm the diagnosis.
• Medical Imaging: In rare or complicated cases, MRI or CT scans may be used to assess deeper or unusually located lipomas.

A healthcare provider will consider the number, location, size, and any symptoms before recommending treatment.

The only definitive treatment for lipomatosis is surgical removal. Unlike a single lipoma, where surgery is relatively straightforward and quick (often completed in 30–40 minutes), lipomatosis can require longer or multiple surgeries, especially if many lipomas are present.

Surgical Procedure Overview

Here’s what to expect if surgical removal is advised:

1. Consultation and Planning: A thorough assessment is made to determine which lipomas to remove and whether multiple sessions will be needed.
2. Local Anaesthetic: Most lipoma removals are performed under local anaesthetic, meaning you’re awake but won’t feel pain in the treated area.
3. Surgical Excision: The surgeon makes an incision and carefully removes the lipoma, including its capsule, to reduce the chance of recurrence.
4. Wound Closure: The incision is stitched in layers to promote healing.
5. Post-Surgical Care: After the procedure, patients are usually discharged the same day with instructions for wound care and follow-up.

Recovery is generally straightforward, but as with any surgery, there is a small risk of infection or scarring.

When Are Multiple Surgeries Needed?

In cases of extensive lipomatosis, it may not be practical or safe to remove all lipomas in a single session. The surgical plan may be spread out over multiple appointments, allowing adequate healing time between procedures.

Lipomatosis is usually a benign but often frustrating condition due to its visible nature and potential discomfort. Although its exact causes aren’t fully known, factors like genetics, alcohol use, and certain medical conditions may increase your risk.

If you suspect you have lipomatosis—or if you’ve noticed a cluster of fatty lumps forming on your body—consulting with a medical professional can provide clarity and relief. Diagnosis is often straightforward, and effective surgical treatment is available, with many people experiencing positive outcomes and improved confidence following removal. Dr Braham Ouali has removed thousands of skin lesions and is renowned for his safe, professional and friendly patient care. Book your consultation here.