Ingrown toenails

This is where the toenail has curled and grown into the skin surrounding the side of the toe. The great toe is the most affected toe and it can occur on either side of the toenail.

Why did I get an ingrown toenail?

There are many contributing causes:

  • Badly cut nails – toenails cut short and round are more prone to ingrowing. Toenails should be cut square and not too short.
  • Tight fitting shoes or socks/stockings/tights – puts pressure on the skin fold
  • Sweaty feet – make the skin softer and therefore makes it easier for the toenail to pierce the skin
  • Injury
  • Fungal infection – leads to nail thickening
  • Naturally curved or fan shaped toenails

Prevention of ingrown toenails involves attending to all the above.

What symptoms might I get?

Ingrown toenails may become swollen, tender and red. Bacteria then get in and pus might then build up or be released from between the nail and the skin fold of the side of the nail.

How are ingrown toenails treated?

  • Soaking in salty baths gives relief
  • Antibiotics if infected
  • See a podiatrist for regular check ups and foot cares – if you have foot problems or other medical problems (eg: diabetes) that alter the feeling in your feet or if you can’t see or reach your toes to attend to them.

What does wedge excision for ingrown toenails involve?

  • You may need either an injection at the base of your toe or some people may need or prefer to have a general anaesthetic for the procedure
  • The nail and the overgrown skin fold are cut all the way to the base of the nail, a special chemical called phenol is applied to prevent regrowth and the toe is dressed
  • You will be able to come in on the day of surgery and go home on the same day
  • You may be discharged on antibiotics and pain relief – once the local anaesthetic wears off you will have pain
  • You will need a first dressing change at 48hours
  • Wear soft or open toe shoes
  • You will need to keep the toe dry (shower with plastic bag over the foot, no swimming) until it heals – at least 2 weeks
  • It will take 6-12weeks to heal completely
  • The nail that grows in future will be narrower
  • You will need to rest and elevate the foot for 2 weeks (you can still walk gently around the house
  • Complications include: cosmetic problems with the nail, recurrence of the problem.

When do I need complete removal of the toenail and what does that involve?

  • If you are having recurrent problems after attempts at wedge excision or if the whole nail is thick and problematic
  • The treatment is similar to having a wedge removal of the nail except that in this instance the whole nail is removed
  • The nail does not grow back and it is perfectly safe not to have a toenail
  • Some people choose to use nail varnish so that the appearance of the absent nail is not so obvious

How effective is surgery?

  • Surgery combined with preventative strategies (good footwear, proper nail cutting technique, clean feet, regular podiatry care if you have other medical problems or cant’s see or reach your toes) is 70-95% successful at preventing recurrence.


Why did I get a hernia in my groin?

We all have a layer of tummy wall muscles that are like a corset that keeps our tummy contents (of bowel and fat) inside the tummy/abdomen. A hernia is a “hole in the corset”.  It is a weakness in the muscles of the tummy wall allowing the contents of the tummy (fat or bowel) to protrude through the hole. Hernias in the groin can occur on one or both sides of the groin.

Heavy lifting jobs, the ageing tummy wall, tummy wall weakness that some people are born with, smoking, medical conditions that weaken the tummy wall, previous surgery, medications that thin tissues can all contribute to the development of hernias.

What symptoms will I have?

  • Lump – painless or painful,  appears on coughing/straining, goes in on lying flat/pushing in
  • May get bigger with time
  • Swelling in the scrotum
  • If the fat gets stuck – very painful lump that does not go back in – this needs urgent repair
  • If bowel gets stuck – very painful lump, doesn’t go in, vomiting, bloating, no passage of bowel motions or wind – this needs emergency repair

What is laparoscopic hernia surgery?

Using 3 small cuts/incisions, carbon dioxide gas is pumped behind the tummy wall muscles, in a layer between the tummy muscles and peritoneum (a thin covering over the bowel) to create a space. The hernia defect is repaired with a man-made permanent mesh much like patching a tire from inside.

What is open hernia repair?

Using a 3-5 inch cut/incision in the groin close to the site of your lump, the hernia is repaired with man-made permanent mesh much like patching a tire from the outside.

Am I a candidate for laparoscopic hernia surgery?

Not everyone can have laparoscopic hernia repair. It is particularly not advisable for those who have multiple medical problems or those who have had some types of prior abdominal surgery as there is an increased chance of injury to structures (such as bowel, bladder, blood vessels) in the abdomen. The assessment of suitability for laparoscopic repair will be made by your surgeon.

How do laparoscopic and open hernia surgery compare?

Laparoscopic hernia repair and open hernia repair have the same outcomes in terms of hospital stay, return to work and recurrence for hernias that are single sided and have not been operated on before.

There is a slightly lower risk of chronic pain associated with laparoscopic repair. Laparoscopic repair is useful where there has been a previous open repair or where there are hernias on both sides to repair.

There is a slightly greater risk of injury to bowel and bladder and groin vessels with laparoscopic repair. There is a slightly greater risk of difficulty with passing urine with laparoscopic repair and also with simultaneous repair of hernias in both groins.

Laparoscopic surgery can only be done under general anaesthetic. Open surgery can be done under general anaesthetic/ epidural, spinal, local anaesthesia.

What are the benefits of hernia surgery?

Relief of discomfort and lump, avoidance of hernia getting stuck

What are the potential complications of hernia surgery?

Potential complications of hernia are injury to bowel and bladder <1% (slightly higher with laparoscopic than open), recurrence of the hernia <10%, inability to continue laparoscopically and hence conversion to open 5%, injury to the tubes that carry sperm to the testicles or vessels to testicles or legs <5%, difficulty passing urine, numbness, chronic pain 10% (tends to occur in people who have had a lot of pain from their hernia pre-operatively, marginally less with laparoscopic). General risks are infection, bleeding, blood clots in the leg or lung. These risks are greater with BMI>30-35 and smoking and diabetes.

Is surgical mesh safe?

General surgeons have used surgical mesh for over 30years for hernia repair and complex breast surgery. Mesh used for groin hernia repair is made of polypropylene, polyester or polytetrafluoroethylene. Without mesh the risk of hernia recurrence is ~30% and with the use of mesh the risk of hernia recurrence is 3-5%. The risk of mesh infection is <1%. There is no significant increase in discomfort.

Because of the success of mesh use in hernia repair, it’s use has been extended to treat vaginal and rectal prolapse. There is a greater rate of local complications such as mesh extrusion and discomfort when mesh is used for rectal and vaginal prolapse. The New Zealand Association of General Surgeons has released a position statement on the use of mesh for hernia repair. This is an excerpt from the position statement:

“The use of mesh in General Surgery to repair hernias of the groin or the abdominal wall is 4 well established internationally and is considered the procedure of choice. 2 For ventral hernias with fascial defects greater than 2cm in diameter mesh must be used to reinforce the tissue repair.3 If not the hernia recurrence rate without mesh is unacceptably high. For groin hernia repair most surgeons worldwide use mesh for the repair. The use of mesh for abdominal and groin hernia repair is safe. Chronic pain may occur after hernia repair in less than 10% of patients. However, it is important to remember that chronic pain after groin hernia repair is higher for patients having non-mesh repair compared to mesh repair. 4 Mesh infection after abdominal hernia repair is uncommon, less than 1%. 5 For laparoscopic inguinal hernia repair it is even lower. The use of surgical mesh is an important part of the curriculum for general surgical training and NZ general surgeons have extensive experience in the use of mesh for hernia repair. The good results of mesh hernia repair in general surgery should not be bought into disrepute by categorising all mesh repairs as the same.”

Is there a non-surgical alternative to hernia surgery?

Hernias do not get better or disappear with time. There is no acceptable alternative to surgical treatment for hernias. A truss (hernia belt) can keep the hernia from bulging for symptomatic relief and is only recommended for patients who are not a surgical candidate.

What would happen is I did not have my hernia repaired?

The natural course for hernias is to get larger, especially with increasing age and weight gain. They can get stuck and painful and require emergency surgery.

What will happen around the time of surgery?

You will have a prior pre-assessment by your anaesthetist by phone or in person  at a pre-assessment clinic to ensure your fitness for surgery. Smoking cessation is important for better recovery from anaesthesia and healing from surgery. Please read your pre-operative preparation instructions carefully. They will tell you when to stop eating and drinking and when to come to hospital for admission on the day of surgery. You will come for surgery on the day of surgery. You will sign a consent form and be looked after by hospital staff. You will be asleep under a general anaesthetic. The procedure takes about 1 hour. Stitches are dissolving, and the dressing is waterproof. You can go home on the same day provided you feel well, there is someone at home to care for you for 24hours after the anaesthetic, you have passed urine. In the first 24-48hours after anaesthetic please do not drive, operate heavy machinery or make any important decisions. You will have some pain at the site post operatively and that will decrease day by day. Initially you will need to take regular paracetamol for 2weeks and may need other regular pain relief as well for the first few days. Once your pain is more tolerable you are welcome to tailor the pain relief to your requirements. Wearing 2 pairs of jockey (not boxers) underwear for the first 2 weeks helps to support the area. Please avoid constipation (your bowels should work within 2-3days)– we can give you laxatives to help. You can remove your dressings in the shower after 1week. Leave the sticky tape dressing on for 2 weeks. It is normal to get some swelling and bruising that extends into the scrotum for the first few weeks. You will be seen in clinic 2 weeks after surgery. You will need 2 weeks off desk jobs and 4 weeks off lifting anything greater than 2kg as well as 4 weeks off sport and any strenuous activities that strain the abdominal wall (mowing the lawn or vacuuming). Occasionally chronic nerve pain may need further investigation or treatment and sometimes the pain can’t be completely fixed and may need referral to a chronic pain management clinic.

When should I seek help post operatively?

Fever >38 deg C or chills
 Persistent vomiting or nausea.
 Increasing abdominal pain or distension.
 Increasing pain, redness, swelling or discharge of any of the wound sites.
 Severe bleeding.
Difficulties in passing urine.
If you are concerned


What are gallstones?

Bile is a soap like fluid (emulsification agent) that the liver produces to aid with digestion of the fatty foods in your diet. Gallstones are hard clumps that form within the bile, most commonly formed in the gallbladder where the fluid is stagnant.

Gallstones can vary in size, shape and number.

Why have I developed gallstones?

Due to an imbalance in the chemical make-up of bile in the gallbladder. In the Western world gallstones are predominantly due to excess cholesterol in the bile and are therefore cholesterol stones.

What is the function of my gallbladder?

The gallbladder functions to help the liver. It concentrates and stores some of the bile that the liver produces and when you have a fatty meal, the gallbladder squeezes to provide extra bile (in addition to that which the liver produces) to help digest the fats in the meal.

Who is more likely to get gallstones?

The risk factors for developing gallstones are:

  • Overweight
  • Female
  • Fasting
  • Sudden weight loss (eg: after weight loss or bariatric surgery)
  • Those with high triglycerides
  • Middle aged
  • Pregnant or on birth control pills
  • Family history of gallstones

What symptoms can I get?

Most people don’t know they have gallstones and the gallstones cause no symptoms. We are finding this more and and more these days because people are increasingly having scans for other problems, on which we accidentally discover that they also have gallstones. Gallstones that are not causing symptoms do not need any treatment.

20% of people with gallstones may get symptoms such as:

  • Pain in the mid or right side of the abdomen that may also be felt in the right shoulder or around the right side of the back
  • Pain that is worse with deep breathing
  • Fevers
  • Jaundice
  • Neon orange urine & pale cream stool

Is there any way of treating gallstones without an operation?

Alternative options are dissolving stones and sound waves to break down stones. Commonly new stones form. There is no good literature to support such techniques as the gallbladder itself is dysfunctional. Hence it is recommended that the gallbladder itself is removed surgically.

Sometimes cutting fatty foods out in your diet may reduce the frequency and severity of attacks. However, this is very hard to keep up long term and it is often then that we discover how many of the foods we consume contain fats.

What would happen if I did not have an operation?

Once you have had an attack of gallstones, there is a 30% chance that you may get recurrent pain or gallstone related complications.

What problems can gallstones cause and what should I do if affected?

  1. No symptoms (found accidentally on a scan done for other reasons)– no treatment required
  2. Pain right upper abdomen (biliary colic) – often starts few hours after fatty meal and eases within a number of hours – if pain can’t be managed with pain relief by mouth at home, go to hospital. Surgery can be done as an elective procedure (non-urgent) within a few months. The risk of recurrent pain is about 30% once you have had an attack of gallstone pain. Although the pain is unbearable sometimes, it is unlikely that you will become very ill with the pain.
  3. Pain right upper abdomen with fevers (cholecystitis) – usually requires admission to hospital for antibiotics +/- surgery as a acute procedure (within a few days of admission. It is very rare to become severely unwell with cholecystitis
  4. Pain with yellow eyes, dark urine or pale stools (choledocholithiasis) – requires admission to hospital for treatment. Treated with ERCP (Endoscopic Retrograde Cholangiopancreatography) where a telescope is passed into your bowel through your mouth under strong sedation to extract the stones that have escaped from the gallbladder and are blocking the bile duct. Then followed a few days later by surgery to remove the gallbladder
  5. Pain with yellow eyes, dark urine or pale stools and fevers (cholangitis) – needs urgent admission and treatment in hospital. Treated by antibiotics & ERCP. With cholangitis, you can sometimes get very sick and require intensive care.
  6. Severe pain in the med back or mid part of the upper abdomen (pancreatitis) – needs urgent admission and treatment in hospital. Treated with fluids, resting the body and resting the pancreas. Attacks of pancreatits can be mild or life threatening. With pancreatitis, you can sometimes get very sick and require intensive care.
  7. There are other complications of gallstones that may occur but these are extremely rare

When should I go to hospital urgently?

If you have any of the following then you should present to the nearest emergency department for review and admission:

  • pain that is not settling or as manageable as it usually is
  •  fevers
  • feel more unwell than usual with your pain

What does laparoscopic gallbladder surgery (cholecystectomy) involve?


  • You will come in on the day of surgery and you will be asleep under general anaesthetic for your operation
  • You will not be able to eat anything after midnight in preparation for your surgery
  • You will have at least 4 small surgical incisions on your abdomen (0.5-2cm size) to perform your operation
  • The operation takes 60-90 minutes and you will spend about the same time in recover before you see you family again on the ward
  • Potential complications are rare (<10%) include: infection, bleeding, injury to stomach/bowel/liver, injury to the tube that carries bile from the liver to the bowel (common bile duct) 3/1000, further stone formation months or years later in the bile ducts, stones trickling into the ducts during surgery (most of these will pass without causing you any problems (<2% cause problems such as pain or fevers), bile leak, atelectasis. Your surgeon will explain these to you in greater detail.
  • There is a 2-3% chance of needing to convert to open cholecystectomy (a long incision under the right rib cage) if it is not safe to continue the surgery keyhole
  • If you feel very well and there is someone to take you home and be with you for 24h then you may wish to go home the same day. If you don’t feel ready to go home then please stay the night in hospital. Always come with an overnight bag packed.
  • You may have some pain in the right shoulder for the first 1-3days due to gas and fluid during the operation . The incisions will be tender and that improves over a few weeks. The incision near your belly button is the most tender.
  • You will need 2 weeks off a desk job and 4 weeks off any heavy lifting (>2kg)
  • You will not be able to drive for about 2 weeks
  • If you have open surgery you will need at least 4weeks off work & driving and 6weeks off heavy lifting


  • Is non-cancerous and does not significantly increase your risk for breast cancer in the future
  • At least 20% of women have this condition but the majority are not bothered by it
  • Most women with this condition have no symptoms
  • For some women it can make the breasts feel lumpy, swollen, painful and tender; especially around the time of your periods
  • The majority of symptoms are felt in the upper and outer part of the breast
  • The cause is not fully understood. It appears though that fibrocystic breasts may have a more pronounced response to female hormonal changes
  • The symptoms improve after menopause
  • Do I need surgery – it is unlikely that you will need surgery for fibrocystic change
  • What can I do to help my symptoms – take paracetamol and ibuprofen for pain, cold or warm compresses may help, taking the oral contraceptive may help if symptoms are severe (consult your GP)
  • Dietary changes – no randomised trials to support – some people find that reducing caffeine intake, reducing fat intake and taking essential fatty acid supplements helpful
  • When to see your GP/Surgeon – if your symptoms are severe or if a lump is not settling within 2weeks, skin redness or changes, nipple flattening, nipple discharge, if you are concerned

Breast lumps investigation

  • Your breast lump investigation when you see your surgeon consists of a triple assessment
  • This means examination by your surgeon, imaging (mammogram, ultrasound or both) and then a biopsy if required (a biopsy is not required if the surgeon’s examination and the imaging both indicate that the lump is prominent normal breast tissue or a benign lump)

Breast Cysts

  • Breast cysts are non-cancerous collections of fluid (fluid filled sacs) in the breast
  • They usually occur in women with fibrocystic change
  • Common in women aged 30-50y and can occur in post-menopausal women on hormone treatment
  • They may change in size with your periods
  • They may cause pain, tenderness, lump & swelling in some women

Types of cysts

  • Small or microcysts – too small to feel but seen on imaging and do not need intervention
  • Big cysts – can be felt and may cause symptoms in some women and are either simple cysts or complex cysts
  • Simple cysts are when there is a smooth wall to the cyst on ultrasound and fluid in the centre and do not usually need intervention – if they are painful or infected then they can be drained
  • Complex cysts are when the wall is not so smooth or there is debris in the cysts or lots of compartments of fluid – these need drainage of the fluid and biopsy of any remaining thickened part of the wall of the cyst (if present)

How is my cyst biopsy or drainage done?

Drainage of a simple cyst does not require local anaesthetic can be done by your surgeon if they can be felt. Biopsy of cysts is usually done under the guidance of ultrasound so that the solid part of the cyst is biopsied preferentially to the fluid filled part. Biopsies of cysts are usually done under local anaesthetic. You can eat and drink normally before drainage or biopsy of your cyst.

After drainage or biopsy of your cyst please take paracetamol regularly for 1day then as required. It is normal to get a little bit of bruising and swelling and tenderness and that will gradually decrease over 1-2weeks depending on the degree of bruising present.


  • Is a very common symptom, especially in pre-menopausal women
  • It is a non-cancerous condition and rarely indicates breast cancer – cancer is generally painless
  • Can be mild to severe
  • Can change with your periods or be the same throughout the month
  • When to see you GP – if the pain is severe, doesn’t improve after 2-3 menstrual cycles, if you are concerned, if you have other symptoms with it such as a lump or nipple discharge or skin rash


  • Your natural body hormones are related to cyclical breast pain. This type of pain often disappears with pregnancy and menopause.
  • Previous breast injury, surgery – pain associated with scar tissue
  • Sometimes breast pain is actually not from the breast itself and may come from pain in the chest wall muscles or ribs or joints or heart or lung and be radiating to the breast
  • fatty acid imbalance – may make the breast cells more sensitive to natural changes in female hormones
  • Medications – infertility treatment, contraceptive pills, hormone therapy for menopause, antidepressants.
  • Breast size – Women with large breasts may experience neck, back and breast pain as a result of breast size

What can I do to help my symptoms?

  • See you GP to determine if you need any further breast investigations
  • Surgery does not help with breast pain at all and can worsen breast pain
  • Eliminate aggravating factors – get bra fitting – most women are wearing the wrong size bra for adequate support
  • Dietary changes – no randomised trials – some women find that caffeine reduction, low fat diet, essential fatty acid supplements may help
  • Paracetamol and ibuprofen (check with your doctor before taking ibuprofen) as required for pain
  • Voltaren gel
  • Warm or cold compresses
  • Change oral contraceptive pill, skip the sugar pill days, reduce dose of post-menopausal hormone therapy
  • Evening primrose oil – a plant-based product for improvement in fatty acid imbalance – helps 60% of women and needs to be taken for 3 months to know if it will be effective. Take 3000mg daily for 6weeks then 2000mg daily for 6weeks and if it works for you then you can continue with 1000mg daily long term. During long term treatment, you can stop this at any point to check if your symptoms are better and determine whether you want to continue with the evening primrose oil
  • Danazol – used only for very severe pain – it causes significant masculine side effects of voice changes, hair growth, acne and weight gain which limits its use
  • Tamoxifen – a drug used for breast cancer treatment – can help with breast pain but has significant side effects of womb lining thickening, endometrial cancer, blood clots in the legs/lungs, mood changes, menopausal symptoms all of which may be more troublesome than the breast pain itself.


Breast screening

  • All women aged 45y to 69y are eligible for free mammograms under the breast screen Aotearoa programme every 2 years
  • The purpose of breast screening is to pick up breast cancers early (before they can be felt) so treatment has a greater chance of being curative
  • Regular screening reduces breast cancer related deaths by 30%

How often should I have a mammogram

  • Regular screening over 40-50y  – annual mammography
  • Regular screening over 50y – 2 yearly mammograms
  • If you have had previous breast cancer – yearly mammograms
  • Mother or sister with breast cancer – annual mammograms starting 10y younger than the youngest person with breast cancer
  • For those with higher risk – see your GP/surgeon for recommendation
  • >69y – regular 2 yearly screening as long as your health is good if you can afford to do so

For mammography

  • You can eat and drink normally
  • You can take your regular medications
  • Please do not apply deodorant, perfumes, talcum powder or lotions to your breasts and armpits
  • Please wear a 2-piece garment for your convenience
  • Approximately a 20-30minute appointment

What is Mammography

  • The breast is held firmly between 2 plastic plates on the mammography machine for a few seconds – this is needed to reduce the thickness of the breast tissue and optimise the image quality and to also hold the breast still
  • soft tissue xray of the breast
  • very low radiation dose (0.4mSv)– the benefits of finding breast cancer early outweight the risks of this dose of radiation. The dose of radiation is less than what we are exposed to in a year from natural background radiation (2-3mSv). The maximum annual radiation dose allowed for humans is 50mSv
  • For most women it is not a troublesome experience
  • If you have had pain or known others who have had pain during mammography that may put you off getting mammograms – taking paracetamol one hour before your mammogram may help you through the process. Also let the radiographer know as there are techniques they can use to reduce your discomfort.
  • Let the radiographer know if you have implants

Tomosynthesis or 3D mammogram

  • Xray machine is used to make thin slices of the breast and reconstruct a 3D image of the breast – much like a CT
  • Advantages – uses less compression, same dose of radiation, less recall (20%), better pick up rate of cancers, fewer missed cancers in dense breasts, better ruling out of benign lumps (fewer unnecessary biopsies required)
  • Disadvantages – 20seconds (slightly longer than standard 2D mammogram)
  • All insurers cover tomosynthesis except southern cross (only covered if suspicious abnormality seen on regular mammogram or prior breast cancer history) – cover will also vary depending on your policy so please check with your insurance company directly
  • $100 additional expense compared to 2D mammogram (approximately)
  • It is a personal choice as to whether you choose to have tomosynthesis, unless your surgeon strongly advises you to have tomosynthesis due to medical/diagnostic reasons


  • Differentiates solid structures from fluid filled cysts in the breasts
  • A gel is applied to your skin to project the sound waves from the machine
  • Please let the radiographer know if you have any tender areas
  • May be needed in addition to your mammogram in the >30y old
  • May be the only investigation required in younger patients
  • Can be used to biopsy or remove fluid from the breast
  • Does not involve x-rays or radiation (uses reflection of sound waves)


  • You will pass through a noisy, enclosed tunnel lying on your tummy with your breasts in a mould
  • The examination takes 30-45minutes
  • Please let the radiographer know if you have any metalware inside your body (clips or pacemakers or artificial joints)
  • Helpful for showing multiple cancers or determining size of cancers not seen clearly on standard mammogram/ultrasound
  • Increases the risk of unnecessary biopsies and anxiety so not used for routine screening
  • Only used where absolutely indicated and likely to change the management of your cancer or for very high-risk patients at the discretion of your medical team


  • A lipoma is a benign (non-cancerous), soft fatty lump and can occur anywhere in the body where there are fat cells
  • Lipomas are not cancerous and do not increase your risk of developing cancer in the future
  • It is not clear why these develop, and it is not related to your diet or activity or anything you have done
  • A few people get multiple lipomas or have a family history of lipomas
  • Most lipomas are painless and do not cause symptoms
  • Lipomas can cause pain if there are over a part of the body that is very active (e.g.: wrist, forearm, neck), pressing on a nerve
  • Most lipomas are small and best left alone
  • Most lipomas are diagnosed by examining you – scans are rarely required to diagnose lipomas
  • If a scan is required your doctor will advise you and this is likely to be an ultrasound or MRI if it is required
  • Lipomas are removed if: they are large >5cm, unsightly or the patient wants them removed, causing symptoms, growing rapidly or if they look abnormal on scans
  • Lipomas that are small and only 1-2 can be removed under local anaesthetic
  • Lipomas that are large may require a general anaesthetic for removal
  • multiple lipomas can be removed under general anaesthetic or one or more sessions under local anaesthetic (removing some of the lipomas each time). Whether the lipomas can all be removed in one session under local anaesthetic will depend on the size and number of lipomas as there is a limit to the amount of local anaesthetic that can be administered at any one time.