SHOULDER LIPOMAS – SURGERY PHOTOS

Photo 1: The highly lobulated lipoma was able to be dissected relatively well from a much smaller incision than the tumor itself.
Photo 2: The only exception of total tumor excision was this very rare case where the lipoma was directly infiltrating into the skin and could not be removed without cutting a piece of skin. However, this would have resulted in significant blood circulation issues in the already thin surgical skin. A challenging intraoperative decision situation where I opted to leave a small portion of the lipoma for removal in a subsequent session. This later proved to be the correct decision.
Photo 3: Shows the extremely thinned skin with the infiltration of the lipoma.

Photo 4: The lipoma is removed and separated from the critically vascularized skin.
Photo 5: The remaining piece of skin is palpated and localized from the inside. The required extent of surgical undermining of the skin becomes evident.

Photo 1: The completely removed, highly lobulated lipoma.
Photo 2: Blood vessels were located within the deep lobulations. Everything was meticulously "shelled out" completely.
Photo 3: The critical areas of the lipoma where it had infiltrated into the skin were marked with threads for the pathologist to examine specifically and in detail. Intraoperatively, I could no longer definitively distinguish between benignity and malignancy. However, it all turned out to be benign, but the lipoma infiltration into the skin was confirmed by the pathologist.

Photo 1: The updated surgical drawing 2 years postoperatively, to excise the remaining lipoma cells that had infiltrated the skin. The new incision had to be nearly 4 cm long.
Photo 2: The intraoperative defect opens widely under natural skin tension after removing the tumor.
Photo 3: In order to close the skin under low tension, the skin needs to be extensively undermined and lifted. This allows for closure with much less tension, promoting better and finer scar formation.

Photo 4: Low-tension skin closure with a double-row aesthetic intracutaneous suture.
Photo 5: The removed skin with the infiltrated lipoma cells "from the inside" after the operation. Complete removal was now also histologically confirmed by the pathologist.
Photo 6: The surgical wound on the 6th postoperative day, with sutures in place. Unfortunately, the patient did not return for follow-up appointments after that.