Lipoma removal is typically a quick and straightforward procedure, often performed under local anaesthetic with a small incision. However, in some cases, a longer incision is necessary to safely and completely remove the lipoma – especially if it’s large, deep, or close to sensitive structures.
While the idea of a larger cut may raise concerns about scarring or recovery, it’s often the best approach to ensure the lipoma is fully removed and doesn’t return. This article explains the situations where a longer incision may be required, how surgeons minimise scarring, and what you can expect during healing.
What Determines the Size of the Incision?
The size of the incision during lipoma surgery isn’t just about the size of the lump – it’s about access and safety. Your surgeon will consider:
- Size of the lipoma – Larger lipomas need more space to be removed intact
- Depth – Deeper lipomas under muscle layers require more careful dissection
- Location – Some areas (e.g. shoulder, thigh, back) may need a longer cut for better exposure
- Encapsulation – Lipomas surrounded by a fibrous capsule often require a larger incision to avoid rupturing the contents
- Surgeon’s technique – Some incisions are slightly longer to avoid excessive pulling or trauma to the surrounding skin
It’s not uncommon for an incision to be longer than the lump appears on the surface – especially when precision and full removal are the goal.
When and Why a Longer Incision Is Necessary
While many small lipomas can be removed through a 1–2 cm incision, certain cases require a more extended approach. A longer incision may be necessary when:
- The lipoma is more than 5–7 cm in diameter
- The lipoma is located in a high-movement area where tissue tension is higher
- The lipoma is close to major nerves or blood vessels, requiring controlled dissection
- The lipoma is lobulated or multilobed, which makes it harder to remove in one piece
- The goal is to remove the lipoma without rupturing the capsule, which can reduce the risk of recurrence
Attempting to extract a large or deep lipoma through a small incision may increase the chance of incomplete removal, tearing, or unnecessary trauma to the tissue – all of which can slow recovery or increase scarring risk.
Does a Longer Incision Mean a Bigger Scar?
Not necessarily. A longer incision doesn’t always mean a more visible scar – especially when careful closure techniques are used. In fact, a clean, well-placed long incision often heals better than a small but stretched or poorly closed wound.
Here’s how surgeons minimise scarring:
- Precise incision placement – Along natural skin lines or folds when possible
- Layered closure – Deep stitches absorb tension and reduce strain on the skin surface
- Fine sutures – Used on the skin surface to support a neater result
- Proper dressing and wound care – Patients are advised on how to clean and protect the area
- Follow-up reviews – To monitor healing and recommend scar management if needed
In many cases, the scar fades well over time and becomes barely noticeable. The priority is always full removal, safe healing, and a cosmetically acceptable result.
