BACK LIPOMAS (UPPER PART) – SURGERY PHOTOS

Photo 1: The deeply lobulated lipoma during removal. Each small lipoma lobe was meticulously and gently excised (ensuring the safety of all nerves). This is why the surgery took nearly 3 hours, performed under local anesthesia.
Photo 2: During the careful intraoperative removal of the lipoma, it's evident that it continues to penetrate deeply.
Photo 3: After removing the lipoma conglomerate, a classic wound cavity and tissue indentation form due to the displacement effect caused by the large tumor.

Photo 1: The surgically removed, deeply lobulated and large lipoma.
Photo 2: The removed lipoma mass from the side view: It appears solid in the center and highly lobulated at the edges.
Photo 3: The excised lipoma, collapsed in my hand. The scar-like fibrous surface structures are visible.

Photo 1: The beginning of the preparation of a fat flap for defect filling.
Photo 2: The already prepared fat flap (made of healthy, locally available fat tissue), delicately lifted by a fine hook.
Photo 3: The same fat flap as in Photo 2 is gently placed into the defect using the fine hook and fixed there with absorbable sutures. The flap is vascularized from the lateral side (outside, on the left side of the image).
Photo 4: The aesthetic skin closure using a double-row, tension-absorbing intradermal suture. The wavy line is due to the sutures and is intentional. The skin slightly retracts laterally (on the left), which is the basis for the vascularization of the fat flap. This retraction is only temporary and will even out over time.

Photo 1: A large lipoma removed from the upper back of a 61-year-old male patient. It can be clearly seen that it is firmly embedded in connective tissue structures, giving it a "scarred" appearance. This is very typical for the upper back and significantly complicates the preparation (surgical removal) of such a tumor. That's why lipomas in the upper back require much more operating time than those in other body areas. The surgical particularity with such lipomas is that due to this "scarring," it's challenging to identify anatomical boundaries, and the lipoma can only be safely removed (prepared) by also removing a narrow strip of surrounding tissue. Otherwise, there is a risk of recurrence.
Photo 2: The same patient as in Photo 1 with preoperative localization of the lipoma.