Gynecomastia + newly developed lipoma

[josh2143]

Dear Dr.'s,

I have had gynecomastia for ~10 years. I am currently 25, and I have developed what is now a large lipoma in my right breast. The lipoma started out as a hard and small bump, which seemed to be distinct from the gynocomastica (it was not directly under the nipple and was instead off to the right side, closer to the center of my chest).

It developed rather quickly, and went from the size of a pea to about the size of peach pit. I was of course worried so I went for an ultrasound, the results of which suggested that it is a benign lipoma (which is now mobile and positioned under my nipple). It is very hard (unlike the tissue on my other breast, which is apparent but smaller, less pronounced, and soft). It is also quite sensitive and at times painful to touch.

My questions are:

1) Do you think there is cause to be concerned about this lipoma turning malignant? I have heard mixed thoughts about this, but because the ultrasound results were not followed up with either a mammogram or a biopsy, I am still somewhat concerned about this.

2) Do you think there may be cause for concern (beyond what is normal) regarding surgical removal of the lipoma? I have several consultations with different surgeons over the next few months, so I am sure I will learn more, but the fact that it is causing me pain suggests that it is not just a distinct lump of fatty tissue, and may instead be physically intertwined with my nerves and glands in this region (although, it surely feels distinct and I can isolate it completely between my fingers).

Your thoughts would be most appreciated.

Best,
Josh

Age: 25
height: 6'0''
weight: 160 lbs
body fat: ~10%

[Litlriki]

Lipomas are common, and pain occurs in many, which commonly demonstrate histology described as "angiolipoma."  These are benign, and they rarely become malignant.  Lipoma removal through a small incision is typically straight forward and fairly simple, and this can be done under local anesthesia.  You don't need a bunch of testing (mammography, ultrasound and so on), but I would suggest that you have the lipoma removed by a plastic surgeon, rather than a general surgeon in order to have it done with the smallest scar possible and to have the scar managed properly afterwards.  I'm not sure what sort of feedback you're looking for regarding your gynecomastia.

Rick Silverman

[Dr. Elliot Jacobs]

I have had some cases similar to what you describe.

One can "lipo" a lipoma, but in the process, the tissue is destroyed (basically, it is homogenized) and cannot be sent to a lab to determine its true identity. Sometimes, if it is located near the areola, an areolar incision can be made and the "lipoma" excised completely or at least biopsied so that a true diagnosis has been made.  Then lipo can be used to remove some/all of the gyne.

IF there is any doubt of what this is, appropriate studies (MRI, mammogram) might be considered.

Dr Jacobs

[DrPensler]

If you have a lipoma as described and a previous incision for gynecomastia it should be straightforward to remove the lipoma without any additional scars. I always try to balance the risks vs the benefits and in your situation the risks seems pretty small.