Lipedema is categorized as lipomatosis, also known as a subcutaneous fat disease that is characterized by abnormal fibrosis of the subcutaneous fat tissue. Fibrosis (also known as fibrotic scarring), is a pathological wound healing in which connective tissue replaces normal tissue, eventually leading to the formation of permanent scar tissue. The fibrosis of Lipedema fat tissue or lipomatosis gives it a hard, nodular feeling when touched.
Early-stage Lipedema (Stage 1) has small nodules the size of small seeds or peas, which often appear pearl-size. Middle stage Lipedema (Stage 2) has larger nodules that feel like the size walnuts or a gumball. Later stage Lipedema (Stage 3) is characterized by the presence of lobules that are typically the same size as the nodules in Stage 2, with other larger nodules up to the size of a plum.
Nodules for the Diagnosis of Lipedema
The nodules felt on the skin are important criteria for diagnosing Lipedema. Nodular or bumpy subcutaneous fat occurs with other conditions or diseases such as cellulite or obesity and other fat disorders, however, subcutaneous nodules must be present to diagnose lipedema. These nodules represent excess and slightly disorganized fibrosis of the subcutaneous tissue. Inflammation of the adipose tissue in lipedema is likely the cause of this fibrosis.
In these cases, fibrosis tissue in Lipedema patients swirl around the adipose tissue, but it usually won’t completely encapsulate it. If the adipose tissue is completely encapsulated by fibrous tissue, eventually it leads to a lipoma. Women with lipedema have an increased number of lipomas, but most of the bumps felt on the skin are nodules, rather than lipomas.
There are other lipomatosis diseases that cause similar side effects as Lipedema to be aware of through the diagnosis process. Dercum’s disease, for example, is characterized by multiple painful subcutaneous lipomas. Madelung’s Disease also has subcutaneous nodules (but not many lipomas), however, these cases occur more in the upper half of the body. Overall, subcutaneous nodules are present in all patients with lipedema but they also occur in other subcutaneous fat diseases or lipomatosis.
Removing Lipomatosis Nodules
In the earlier stages of Lipedema (Stage 1 and most patients in Stage 2), the subcutaneous nodules are removed with lipedema reduction surgery, which involves modification of cosmetic liposuction using tools and techniques which minimize harm to the lymphatics. In lipedema patients with larger or more adherent nodules, the nodules have to be manually extracted.
In these cases, a small incision is made over the lipomatosis nodules that resist removal with a suction cannula and are gently milked out of the skin. Obviously, surgeons don’t want to cause any more trauma than is absolutely necessary, however, there are instances where this method is the only way to get larger, more adherent nodules removed.