Epididymal Lipomas: Surgical Considerations and Options

Spermatic cord lipoma

Hello, doctor.
When I was about 15 years old, I underwent surgery for an inguinal hernia (traditional suturing surgery, with an incision approximately 10 cm long).
Recently, I experienced a muscle strain in the groin area and visited a urologist to check for a possible hernia recurrence.
During the ultrasound examination, it was unexpectedly discovered that I have a subcutaneous lipoma approximately 1 cm in diameter at the junction of my right scrotum and penis.
It is usually painless, but I have some questions:
1.
What is the typical diameter at which surgery is recommended for a lipoma?
2.
After surgery, is there a high chance of recurrence at the same site?
3.
If the lipoma is currently 1 cm in diameter, is it relatively easy to remove? I was told by a previous physician that small ones can be difficult to excise.
4.
How is surgery typically performed in this special location of the scrotum? Is the incision made directly on the scrotum, or is it done through the previous inguinal hernia incision, or another method?
5.
Which specialist would be more suitable for my current situation: urologist, surgeon, or plastic surgeon?

Ken, 30~39 year old female. Ask Date: 2017/09/28

Dr. Chen Jiaming reply Surgery

Since the lipoma is asymptomatic (discovered only through ultrasound), there is no necessity for surgical removal.
First, the presence of lipomas in this area is quite common (especially when found during hernia surgery, they are often removed incidentally).
Typically, they are harmless and asymptomatic.
Additionally, the postoperative wound care in this area (where your lipoma is located) can be challenging and prone to infection, so it is not advisable to be concerned about it.
The lipoma would only be removed incidentally if you experience a recurrence of hernia during surgery.

Reply Date: 2017/09/28

More Info

Epididymal lipomas, or lipomas located in the scrotal area, are benign tumors composed of adipose (fat) tissue. They are generally asymptomatic and often discovered incidentally during imaging studies or physical examinations. Your concerns regarding surgical considerations and options are valid, and I will address each of your questions in detail.

1. Size Considerations for Surgery: There is no strict size threshold for when surgery is recommended for lipomas. However, surgical intervention is typically considered when a lipoma becomes symptomatic (causing pain or discomfort), grows significantly, or if there is uncertainty regarding the diagnosis. In your case, since the lipoma is currently not causing pain and is relatively small (1 cm), surgery may not be immediately necessary unless it starts to cause issues or grows larger.

2. Recurrence After Surgery: Lipomas can recur after surgical excision, but this is relatively uncommon. The likelihood of recurrence depends on the completeness of the excision and the characteristics of the lipoma itself. If the entire lipoma is removed, the chances of it returning to the same site are low.

3. Surgical Removal of a 1 cm Lipoma: A lipoma of 1 cm in diameter is generally considered small and can usually be removed with relative ease. The concern that it may be "too small" to remove is often related to the difficulty in locating and excising it completely. However, a skilled surgeon should be able to perform the procedure effectively, even for smaller lipomas.

4. Surgical Approach: The surgical approach for removing a lipoma in the scrotal area typically involves making an incision directly over the lipoma. This allows for direct access and removal. In some cases, if the lipoma is located near the previous inguinal hernia incision, the surgeon may choose to use that incision for access. However, this decision will depend on the specific location of the lipoma and the surgeon's judgment.

5. Specialty Consultation: Given the location of the lipoma, it would be appropriate to consult with a urologist or a general surgeon. Urologists specialize in conditions related to the urinary tract and male reproductive system, while general surgeons are trained to handle a wide range of surgical procedures, including soft tissue tumors like lipomas. If cosmetic considerations are significant to you, a plastic surgeon may also be consulted, especially if you are concerned about scarring or the aesthetic outcome of the surgery.

In summary, while your lipoma is currently asymptomatic and small, it is essential to monitor it for any changes. If you decide to pursue surgical removal, a consultation with a urologist or general surgeon would be advisable. They can provide you with a thorough evaluation and discuss the best surgical approach tailored to your specific situation. Remember that the decision to operate should be based on a combination of factors, including symptoms, size, and personal preference. Always feel free to ask your healthcare provider any questions or express concerns you may have regarding the procedure, recovery, and potential outcomes.

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