NECK LIPOMAS – SURGERY FOTOS

The beginning of the operation.
The hairy head and face were thoroughly disinfected multiple times so that the patient did not have to endure any restrictions caused by sterile coverings on the face. This is certainly a significant advantage during a long operation.
Photo 1: After the skin was cut, it was revealed that the lipoma had grown extensively down to the hair roots beneath the dermis. On one hand, the lipoma had to be completely removed, but on the other hand, we were determined to preserve the hair roots for the postoperative aesthetic outcome. It was like a "surgical tightrope walk."
Photo 2: I worked my way deeper step by step, always respecting and preserving the delicate lipoma capsule to prevent any potential recurrence (reappearance of the lipoma). Blister-like tumor structures were dissected (surgically prepared) progressively.
Photo 3: As I delved deeper, new and sometimes very delicate bud-like lipoma structures emerged. Each one had to be respected, displayed, and prepared to prevent a recurrence. These are particularly time-consuming surgical steps (see the patient's surgical video for more details).

Microsurgical progress into the depth of the neck:
Photo 1: The surgical scissors point to the niche in the neck where the lipoma had penetrated under the pressure of its growth. The numerous dark spots represent each individual sealing of blood vessels using tissue-friendly, pinpoint bipolar current. This allows the surgeon to maintain an overview and safely identify all essential anatomical structures.
Photo 2: The part of the enormous lipoma on the head side has already been largely exposed, but the lipoma is still firmly situated in the neck area, and it is pressing against the main nerve. To avoid extending the future scar too far – the "aesthetic aspect" of tumor surgery – I decided to endoscopically undermine and peel the neck lipoma from the depth. This was eventually successful and safe.
Photo 3: Now, the neck lipoma has been prepared (detached) from the depth.

What came out of this:
Photo 1: The completely removed lipoma, along with the undamaged lipoma capsule, is carefully examined and photographed again postoperatively in case any specific questions arise during the pathological examination. The lipoma has collapsed upon removal from its connective tissue attachment within the body, shrinking by about one-third but still approximately 15 cm in length. The bulky part was located in the head region and is marked with a thread at "12:00" (on the right side of the image) to precisely define the tumor's position in the body for the pathologist examining it at the microscopic level (histologically). The slender portion of the lipoma (on the left side of the image) infiltrated the neck area toward the chest.
Photo 2: During the postoperative examination of the resected specimen (the removed growth), the "intraoperative challenges" become evident once again: the lipoma extensions that had worked their way deeper and elongated. Overall, this operation was performed on 4-5 different tissue layers until the surgical dissection finally reached the "base" of the lipoma's extent within the neck.