Lipomas are tumours of soft, fatty tissue which form between the skin and the muscular layer and are not malignant.

It is not uncommon to describe them also as tender, mobile and non-tender.

This condition called Multiple Lipomatosis could be a worrisome factor with people who have it.

It is therefore important to get to know how frequent multiple lipomas are, who is susceptible to it so that early detection and treatment can be made.

In this blog by Mykare Health, the cases of multiple lipomas, factors that increase one’s risk, heritable pattern and management that is possible are discussed.

What is a Lipoma?

A lipoma is therefore a growth on the human body formed of fat tissues which are abnormal but non cancerous. Lipomas may be small localised nodules or form large tumours which may be painful or cosmetically disturbing. Most of them are sessile, round or oval in shape and soft in consistency; they can be shifted slightly under the skin.

The lipomas in most of the instances do not become malignant formations, and thus are considered cosmetic or minor health concerns rather than emergencies. However, the presence of multiple lipomas may sometimes be suggestive of a genetic disease which should be further investigated.

How Common Are Lipomas?

This type of growth is not rare; individual lipomas are found in approximately 1% of the population. They normally develop in adults between 40 and 60 years, although they can evolve at every age.

Lipomas affect both men and women and can develop anywhere on the body but they are seen most often on the upper back, shoulders, abdomen and thighs.

Lipomas that develop in various locations around the body, however, are not as common. This study has also established that if a person develops more than one lipoma this implies there is a genetic aspect or another disease.

Individuals usually develop multiple lipomas and this is usually as a result of genetic disposition where many members of the family have the same growths.

Understanding Familial Multiple Lipomatosis

Familial Multiple Lipomatosis (FML) is a genetic condition characterised by the development of numerous lipomas, often in clusters, across the body. This condition is inherited in an autosomal dominant pattern, meaning that a person needs only one copy of the defective gene from one parent to develop the disorder. Individuals with FML often begin developing lipomas in early adulthood, and the number of lipomas tends to increase with age.

In most cases, FML is not life-threatening, but the presence of numerous lipomas can cause physical discomfort, restrict movement, or cause emotional distress due to the appearance of these lumps. Because of its genetic nature, those with a family history of FML have a higher risk of developing multiple lipomas.

Who is at Risk for Developing Multiple Lipomas?

Certain factors can increase the likelihood of developing multiple lipomas. These include

• Genetic Predisposition: Individuals with a family history of multiple lipomas are at a significantly higher risk. Familial Multiple Lipomatosis is the most well-known hereditary condition associated with multiple lipomas.

• Age: Multiple lipomas are more commonly seen in adults between the ages of 30 and 60. Although lipomas can appear at any age, the development of multiple lipomas usually occurs in middle-aged individuals.

• Gender: Men are more likely than women to develop multiple lipomas, especially in conditions like Madelung’s disease, where fat accumulation occurs symmetrically around the neck and shoulders.

• Obesity : While lipomas are composed of fat cells, their development is not directly linked to obesity. However, some research suggests that people who are overweight might have a higher incidence of lipomas, particularly multiple ones.

• Metabolic Disorders: Metabolic disorders such as diabetes or high cholesterol have been associated with a higher risk of lipoma development. The connection is not entirely understood, but some theories suggest that these conditions may influence fat metabolism in the body, leading to lipoma formation.

• Alcohol Use Disorder: There is definitive acknowledgement of the fact that multiple symmetric lipomatosis which is also referred to as Madelung’s disease is highly linked to alcoholism. This condition leads to the development of multiple lipomas on certain parts of the body eg neck, upper back and arms.

• Trauma or Injury: For that matter, there are indications that lipomas may occur as a result of an injury or trauma in the region. This is called post-traumatic lipoma. Now while it may not be a frequent cause, it needs to be taken into consideration all the same.

Genetic Conditions associated with Multiple Lipomas

As highlighted FML is a hereditary condition whereby many lipomas are distributed all over the body. It is normally harmless but may, however, be painful if it is located near nerves or joints and applies pressure on them.

• Gardner’s Syndrome: Gardner’s syndrome is a rare inherited polyposis syndrome with lipomatous tumours, fibromas and intestinal polyps. It is associated with an inherited condition that is caused by a mutation in the APC gene. Colorectal cancer associated with Gardner's syndrome thus indicates that relatives need to be checked early.

• Madelung’s Disease : Multiple symmetric lipomatosis or Madelung’s disease or Launois-Bensaude syndrome describe a condition whereby extra fat deposits are seen in the upper part of the truncal region and the neck. It is mainly observed in male with AUD and is connected with metabolic derangement.

• Dercum’s Disease: Adiposis dolorosa or Dercum’s disease is characterised by multiple painful lipomas commonly found in the limbs and the trunk. It is still uncertain what triggers the disease, although it is predominant among women, and its effects may include sharp pain and constant fatigue.

Diagnosis of Lipomas

Differential of multiple lipomas has been defined and often includes physical assessment and family history assessment. When a health care provider is in doubt of a genetic disease, the genetic test is advised. Ultrasound or MRI may also be employed to assess the size, frequency, and precise location of the lipomas especially with a view to operation.

In certain circumstances, you may have a biopsy done in order to exclude other types of soft tissue swelling that may mimic lipomas or liposarcomas (disease of lip cells cancerous growths, which may look like lipomas). The biopsy simply includes taking a small part of the lipoma growth and analysing it under a microscope.

Treatment of Lipomas

Many lipomas are asymptomatic and do not require intervention, although they can be surgically removed or treated if the tumours are causing pain, discomfort or causing distress to the patient.

1. Surgical Removal

Although lipomas are benign growths and can often be watched, surgery is recommended as the most appropriate approach towards their removal. It is often performed locally, and the whole lipoma mass is removed. This operation is considered when lipomas are big, cause pain or interfere with an individual’s ability to move around.

2. Liposuction

Liposuction is considered to be safer than the surgeries because the doctor uses a needle and syringe to extract the fatty tissue. However, it may not excise the entire lipoma and therefore raises chances of a re-occurrence.

3. Steroid Injections

That said some lipomas can be vaporised through a steroid injection but this only helps in reducing the size without completely eradicating the formation. This may be used where lipomas are smaller and cannot be operated to be removed from the body.

4. Laser Therapy and Lipolysis

Laser therapy and lipolysis are the utilisation of heat to dissolve the fatty component of the body and are almost non- intrusive. These classes of drugs are not very popular and may be used for aesthetic reasons only.