Mr. Onur Gilleard
Qualifications & Experience
Mr Onur Gilleard is a distinguished consultant plastic surgeon on the GMC specialist register. He previously held an NHS consultant post at St Bartholomew’s Hospital in London, specialising in skin cancer and microsurgical reconstruction. In 2021, Mr Gilleard transitioned from the NHS to dedicate himself fully to private practice, allowing him to focus exclusively on providing personalised, high-quality care to his patients. He is recognised as an expert in laser treatments, having conducted research and developed advanced treatment protocols using cutting-edge laser technology to optimise both clinical outcomes and cosmetic results.
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The working answer is 5 cm. Below that, a lipoma is ordinary and the question is whether it bothers you. At or above it, the threshold for investigating before operating drops sharply — not because large lipomas are usually dangerous, but because size is one of the few features that separates a benign fatty lump from the rare tumour that mimics one. Size also changes the operation itself, which is the part people find out about late.
A Size Scale That Means Something
| Size | Description | What it usually means in practice |
|---|---|---|
| Under 2 cm | Small | Often barely visible. Removed for irritation or appearance, straightforward under local anaesthetic. |
| 2–5 cm | Typical | The commonest range. A short procedure; the incision is usually shorter than the lump is wide. |
| 5–10 cm | Large | Imaging before surgery becomes the default rather than the exception. Planning matters — cavity, closure, sometimes a drain. |
| Over 10 cm | Giant | Uncommon. Assessment first, and the setting for surgery is a decision in itself rather than an assumption. |
These bands are practical rather than official. There is no diagnosis that switches on at a particular centimetre — but 5 cm is the figure that most often changes what a surgeon does next, which makes it the useful one to know.
Why 5 cm Is the Number That Matters
The great majority of fatty lumps are simple lipomas at any size. The reason size carries weight is that a liposarcoma — a malignant tumour of fatty tissue — can look and feel like a lipoma from the outside, and the features that distinguish the two are few. Size is one of them.
It never operates alone. The picture that prompts investigation is size plus one or more of the following:
- Depth. A lipoma sits in the fat just under the skin and slides freely. One lying deep to the muscle fascia, or feeling fixed rather than mobile, is a different proposition regardless of its diameter.
- Growth. Lipomas enlarge slowly over years. Change measured in months is the feature that carries the most weight of all — more than absolute size.
- Consistency. Soft and doughy is typical. Firm or hard is not.
- Pain. Most lipomas are painless unless they press on a nerve. Persistent pain warrants investigation.
A soft, freely mobile 6 cm lump on the back that has been there for a decade and has not changed is very different from a firm 6 cm lump on the thigh that appeared over four months. Both are “large”. Only one is concerning.
What Actually Triggers a Scan Here
Size is the number people fixate on, but it is not how the decision is made in practice.
“If a lump is large, deep, growing quickly, unusually firm I investigate it with imaging before considering surgery.”
The findings that prompt imaging before anything is removed:
- Over 5 cm
- Deep to the fascia, or difficult to define clearly on examination
- Rapid growth over weeks to months rather than years
- Firm, irregular or fixed rather than soft and mobile
- Persistent pain without another explanation
- Any diagnostic uncertainty on examination
Note that only the first of those is about size. A soft, mobile, unchanged 6 cm lipoma on the back is a different proposition from a firm 3 cm lump that has appeared over two months.
Which Scan, and How Quickly
Ultrasound is the first investigation, and it is done in-house at 101 Harley Street by a consultant radiologist — frequently on the same day as the assessment, which is the part that usually surprises people. MRI is preferred where the lump is deep, large, or where the ultrasound is indeterminate. All imaging is reported by a consultant radiologist with musculoskeletal and soft-tissue expertise.
How Size Changes the Operation
This is the part that rarely appears on a price list, and it is why a 2 cm forearm lipoma and a 9 cm back lipoma are not the same procedure with a different sticker.
- The incision
- Shorter than most people expect. Fatty tissue delivers through an opening smaller than the width of the lump, so the scar is not proportional to the diameter. Larger lipomas do need longer incisions, but not as long as the lump is wide.
- The cavity
- Removing a large lipoma leaves a space where it used to be, and that space can fill with blood or tissue fluid. This is the practical reason large removals need more attention afterwards, and occasionally a drain or a compression dressing.
- The anaesthetic
- Local anaesthetic covers most lipomas comfortably. There is a limit to the total dose that can be given safely, and for very large lesions, several at once, or deep intramuscular ones, general anaesthetic in a theatre setting becomes the appropriate choice.
- The recovery
- Longer and achier, mainly because of the cavity rather than the skin. The recovery timeline stretches accordingly.
- Whether it is done here at all
- Where a lesion is large, deep or otherwise complex and needs a general anaesthetic, it is not sent elsewhere: it is booked into the clinic’s own main operating theatre at 101 Harley Street, with the clinic’s own anaesthetists. What changes is the setting and the anaesthetic, not the surgeon.
A case from the clinic. A woman in her forties came in with a 10 cm lipoma of the upper back that was uncomfortable to lie on. The planning before the operation was about three things: where to place the incision, the dead space the lipoma would leave behind, and how to close the wound without tension. It was removed intact with its capsule, histology confirmed a benign lipoma, and the wound healed without complication.
Where Local Anaesthetic Stops Being the Right Answer
The largest lipoma removed under local anaesthetic in this clinic was around 12 cm — a carefully selected case rather than a routine one. Beyond that, and in certain situations regardless of size, a general anaesthetic is the better plan:
- Very large, roughly over 10 to 15 cm
- Deep to the fascia
- Fixed rather than mobile
- Close to major nerves or vessels
- Imaging showing atypical features
This does not mean being sent elsewhere. These operations are done under general anaesthetic in the clinic’s own theatre at 101 Harley Street, by the same surgeon, with the clinic’s own anaesthetists. Pricing for a general anaesthetic case is quoted individually, because it has to account for the anaesthetist, a surgical assistant where needed, specialist equipment and total theatre time — rather than the standard £450 that applies to a superficial lipoma under 5 cm.
Growth Beats Size
If you take one thing from this page, take this: a lump that is changing matters more than a lump that is big.
Lipomas grow, but slowly — they are usually described in years rather than months. Something that has visibly enlarged over a few months, or that has changed in feel from soft to firm, is worth assessing whatever the tape measure says. A stable lump you have had for fifteen years is doing what lipomas do.
The practical way to track this is not to guess. Photograph it beside a coin or a ruler, same angle and lighting, every couple of months. That produces something a clinician can actually use — the approach is set out in monitoring lipoma growth, and how freely it moves is the other half of the same assessment.
What Happens at the Assessment
Examination establishes size, depth, mobility and consistency, and whether the lump lies above or below the muscle fascia. Where the picture warrants it, ultrasound is arranged before surgery rather than after — because imaging changes how the operation is planned, and finding out afterwards is the wrong order. MRI is used where the anatomy is complex or the ultrasound leaves questions.
Where the lump sits at the navel, in the groin, in the abdominal midline or over an old surgical scar, one further thing is excluded first: some hernias contain nothing but fat and feel exactly like lipomas — see lipoma or hernia.
Consultation and removal: lipoma removal or contact the clinic.
Everything Goes to the Laboratory
One policy worth stating plainly, because clinics differ and patients ask: every piece of tissue removed here is sent for histopathological examination — not a selected subset. It confirms the diagnosis and rules out anything unexpected.
How often does it find something? Once in five years, in this surgeon’s practice, a fatty lump has turned out to be something other than a simple lipoma. That is the honest scale of it: rare, but not zero, and the reason the specimen goes to the lab every time rather than when someone remembers to ask.
If histology did come back showing an atypical lipomatous tumour or a liposarcoma, the patient is contacted promptly and referred urgently to the regional specialist sarcoma multidisciplinary team, with any further imaging, staging and surgery coordinated through that service.
“Most fatty lumps are simple lipomas, but it is possible that any abnormal growth can be cancer however low the chance. Rest assured I have treated thousands of lipomas and have worked in specialist sarcoma units so you are in very safe hands.”
Common Questions
- What size lipoma is considered large?
- Around 5 cm is the working threshold. Below it, most lipomas are treated as ordinary; at or above it, imaging before removal becomes the default. Over 10 cm is usually described as giant and is uncommon.
- Does a large lipoma mean something is wrong?
- Usually not. Size alone is a weak signal; it carries weight when combined with depth, rapid growth, firmness or pain. A soft, mobile, long-standing 6 cm lump is very different from a firm 6 cm one that appeared over four months.
- Will I need a scan?
- Likely if the lump is over about 5 cm, lies deep to the muscle fascia, feels fixed or firm, is painful, or has grown noticeably over months. Ultrasound is the usual first test, with MRI where the anatomy is complex.
- Can a large lipoma be removed under local anaesthetic?
- Often yes. The limits are the total safe dose of local anaesthetic, the depth of the lesion and how many are being removed at once. Very large, deep or multiple lipomas may be better done under general anaesthetic in a theatre setting.
- Does a bigger lipoma mean a bigger scar?
- A longer one, but not proportionally. Fatty tissue delivers through an incision shorter than the width of the lump, so the scar is usually smaller than people expect. Keeping the wound out of tension for two weeks influences the final result more than the length does.
- How fast do lipomas grow?
- Slowly — over years rather than months, and many stop growing altogether. Noticeable enlargement over a few months is the pattern that warrants assessment, and it matters more than the size the lump has reached.
- Can a large lipoma shrink or be dissolved?
- No. Lipomas do not resolve on their own and there is no cream, supplement or injection that reliably removes one. Surgical removal is the only definitive treatment — the alternatives are covered in non-surgical options.
- Is it safe to leave a large lipoma alone?
- Once it has been assessed and is confidently a lipoma, yes — removal is then a matter of symptoms and preference. The part that should not be left is the assessment itself, particularly where the lump is large, deep, firm or changing.
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