"Collar" on the neck
Soft symmetrical thickenings on the front and back surfaces of the neck, under the chin, on the occiput.
CONDITION / TUMOURS
Madelung's disease.
Madelung's disease (symmetric lipomatosis) is a rare condition in which soft fat masses symmetrically grow on the neck, occiput, shoulders, and upper torso. They can be removed, but it is also important to undergo an examination.
CONCEPTUAL VISUALIZATION- What it is
- A rare disease: fat without a capsule grows symmetrically on the neck, shoulders, and torso.
- How common
- In a study in Germany — roughly 1 person out of 25,000 in the area served by the clinic.
- Who is sick
- In a review of 77 studies (436 operated patients) 76% were men, the average age was 49.8 years.
- Treatment
- There are no drugs that remove these fat masses. They are removed surgically, but they can reappear.
01 / WHAT IS ITWhat is
What is
Madélung's disease.
Madélung's disease is a rare fat metabolism disorder. Fat tissue grows symmetrically and has no capsule, so it is not separated from muscles and adjacent tissues like a regular lipoma. The neck is most often affected: fat surrounds it like a collar — doctors call it: "Madélung's collar."
Doctors distinguish several types. The most common is type I: fat on the neck, the occiput, and the upper body. In type II, a person looks as if they have ordinary obesity; in a study of 11 women and 58 men, all the women had type II, and their fat was more often deposited on the upper arms and legs.
Although these fat masses are not cancer, the disease is not considered purely cosmetic. Fat can grow inward — around the airways and in the mediastinum, the space in the chest between the lungs. In a long-term observation of 31 patients (on average 14.5 years), the disease was accompanied by significant complications, and the authors concluded that it should not be called 'benign lipomatosis.'
Therefore, in addition to fat removal, a person with Madelung's disease needs an examination: there are often associated liver diseases, metabolic disorders, nerve issues, and sleep apnea.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow
How
Madélung's disease presents.
Fat masses grow slowly, over the years. They usually do not hurt — this distinguishes the disease from some other conditions with fatty nodules.
Shoulders and torso
Fat accumulates above the collarbones, on the shoulders, upper back, and chest; in women, it more often occurs on the upper arms and legs.
Swallowing and breathing
When fat grows around the airways and esophagus, shortness of breath and difficulty swallowing may appear.
Sleep
Snoring, pauses in breathing during sleep, daytime fatigue — signs of sleep apnea, which may accompany Madelung's disease.
Nerves
Numbness, tingling, decreased sensitivity in the feet. In a study of 33 patients, signs of nerve damage were present in 84%.
Separate nodule
A single soft nodule under the skin without symmetry is another condition, for example, a lipoma. It should also be shown to a doctor.
Lipomas of the head, face and neck03 / REASONSWhy does it occur?
Why does it occur?
Madélung's disease.
The exact cause is unknown. Among possible mechanisms are mitochondrial dysfunction, the “power stations” of fat cells.
Alcohol
The disease is often associated with prolonged alcohol consumption: in a Portuguese series of 59 operated patients, 86% reported excessive alcohol use, either current or past. However, the disease can occur without this, and the exact role of alcohol is still unclear.
Gender and age
Middle-aged men are more often affected. However, in a German study of 45 patients, there were more women than men.
Heredity
Familial cases have been described. A rare form is caused by changes in the MFN2 gene — in this case, the disease is accompanied by nerve damage.
Metabolism
High cholesterol, thyroid disease, liver disease, obesity are common.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Madelung’s disease develops over years and usually does not require urgent care. It is dangerous when fat compresses the airways: then urgent care is needed.
103 immediately if:
- it is very difficult to breathe: a person gasps for air with his mouth, suffocates or cannot utter words;
- lips or skin become very pale, blue, or gray;
- sudden confusion of consciousness;
- convulsions began after quitting alcohol;
- after quitting alcohol, a person sees, hears, or feels things that are not there;
- after quitting alcohol, a person is noticeably trembling or unusually excited, irritable, or upset.
Do not delay a visit to the doctor:
On the same day: shortness of breath is stronger than usual; difficulty swallowing, the person chokes while eating or drinking, feeling that food is stuck in the throat; shortness of breath after eating. In the coming weeks: shortness of breath worsens when lying down or during normal activities; relatives notice pauses in breathing during sleep, snoring, you constantly feel sleepy during the day; numbness or tingling appeared in the feet. Planned: fat masses grow, interfere with moving the head, wearing clothes, or you want to remove them.
05 / DIAGNOSTICSAs defined,
As defined,
what to treat
- Discussion and review
When fat masses appear, whether they grow, or hinder swallowing, breathing, sleeping; what diseases and medications exist, whether you consume alcohol. The doctor examines and palpates the neck, shoulders, torso.
- MRI or CT
They show exactly where the fat lies, how the major blood vessels run, whether there is any compression of the trachea and nodes of other nature. For planning surgery, both methods provide sufficient data; ultrasound is less informative.
- Examination of the respiratory tract
If there is shortness of breath or difficulty swallowing, an ENT doctor examines the larynx and pharynx, if necessary — with an endoscope. The cause is not attributed to fat until a respiratory tract tumor is ruled out.
- Tests and concomitant diseases
Blood tests for cholesterol, liver function, and thyroid; if necessary — sleep study and neurologist examination.
- Histology
The removed tissue is examined under a microscope to confirm that it is fat without signs of malignant tumor.
06 / TREATMENTHow we treat
How we treat
Madélung's disease.
If the fat does not interfere and does not compress the airways, it can be observed. It is removed when it disrupts breathing, swallowing, neck movements, or noticeably changes appearance.
01
Surgery
The only proven way to remove fat masses.
- Lipectomy
- Open removal of fat through incisions. It is more often chosen for large, dense masses: the surgeon can see the vessels and nerves and can remove more tissue.
- Liposuction
- Fat is suctioned through small punctures. This is less traumatic and suitable for superficial fat, but it is difficult to remove large masses this way.
- Combination
- Part of the fat is removed openly, part by liposuction. The choice depends on where and how much fat there is and what the patient expects.
- Complications
- The most common are hematoma (blood accumulation) and seroma (fluid accumulation) under the skin. In the Portuguese series, complications occurred after 17.8% of interventions.
02
Fat recurrence
Long-term follow-up is required after the operation.
- How common
- In a systematic review, fat reappeared in 18.3% of cases. In a series of 59 operated patients — in 39%, on average after 3.8 years.
- Repeat operations
- Because of this, some people need several interventions — on the same or other areas.
03
Lifestyle and comorbidities
- Alcohol and smoking
- Doctors recommend giving up alcohol and smoking as early as possible due to comorbidities of the liver, nerves, and heart. But the only proven way to remove fat is surgery, and after it, fat can return even in those who have stopped drinking.
- Safe refusal
- If there is alcohol dependency, quitting drinking abruptly is dangerous. Do it under a doctor’s supervision.
- Other diseases
- Cholesterol, the thyroid gland, liver, and sleep apnea are treated by the respective doctors. In a study of 54 patients, 20.37% also had malignant tumors, more often of the digestive system, so a general examination is important.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Madelung’s disease is treated at the Doctor Valikhnovskyi Institute of Surgery in the 'Soft Tissue Oncosurgery' department: the clinic is responsible for preoperative examination, removal of fatty masses, and tissue restoration. Comorbidities, alcohol cessation, and sleep apnea are managed by specialized doctors.
CLINIC SERVICE
Oncosurgery of soft tissues
Sarcomas and other soft tissue tumors — with preservation of the limb and restoration of tissues in the same operation.
View service
What we do for this condition
- MRI before surgery — to see where the fat lies and what is nearby even before the procedure.
- 3D modeling — if necessary, MRI and CT data are combined into a three-dimensional model, allowing the surgeon to see how fatty masses are positioned relative to major vessels and nerves.
- Removal of soft tissue tumors — with tissue restoration during the same surgery if needed.
- Histology — A pathomorphologist examines the removed tissue under a microscope.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend photos of the neck and shoulders from the front, side, and back, as well as MRI or CT scans, if available.
- ConsultationExamination, MRI assessment; if necessary — referral to an ENT specialist, endocrinologist, or neurologist.
- PlanWhat to remove first, by which method, and whether multiple stages are needed.
- SurgeryRemoval of fat masses; the removed tissue is examined under a microscope.
- SupervisionPostoperative check-ups, and afterwards regularly, to detect in time if the fat starts growing again.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Is Madelung's disease cancer?
No, the fatty masses themselves are not malignant. But the disease can cause serious complications: compression of the airways, nerve damage. Therefore, it is treated and examined, not just fat removed.
Will diet or medication help?
There are no medications that remove these fatty masses. The only proven method is surgical removal.
Will the fat disappear if I stop drinking?
Fatty masses can only be removed surgically, and fat can return even in those who have stopped drinking. But quitting alcohol and smoking is important for the liver, nerves, and heart, so doctors recommend it — under medical supervision if there is an addiction.
Liposuction or open surgery?
Liposuction is less traumatic and suitable for superficial fat. Large dense masses are more often removed openly. Often, both methods are combined — the plan is made after an MRI.
Will the fat return after surgery?
Maybe. In the review of studies, fat reappeared in 18.3% of cases, and in some series — more often. Therefore, long-term follow-up is necessary after surgery.
Why is it hard for me to swallow and breathe?
Fat can press on the airways or esophagus. But such complaints need to be examined by an ENT doctor: they can also be caused by other throat diseases.
Sources
20 sources · systematic reviews, cohorts, and NHSshowCollapse
- Madelung Disease Epidemiology and Clinical Characteristics: a Systemic ReviewAesthetic Plastic Surgery, 2021doi:10.1007/s00266-020-02083-5 ↗
- Liposuction, lipectomy, or combined techniques for Madelung’s disease: A systematic reviewJournal of Plastic, Reconstructive & Aesthetic Surgery, 2026doi:10.1016/j.bjps.2026.02.031 ↗
- Madelung’s Disease: Lipectomy or Liposuction?BioMed Research International, 2018doi:10.1155/2018/3975974 ↗
- Multiple symmetric and multiple familial lipomatosisLa Presse Médicale, 2021doi:10.1016/j.lpm.2021.104077 ↗
- Multiple symmetric lipomatosis: a rare disease and its possible links to brown adipose tissueNutrition, Metabolism and Cardiovascular Diseases, 2015doi:10.1016/j.numecd.2015.01.010 ↗
- Multiple symmetric lipomatosis: clinical aspects and outcome in a long-term longitudinal studyInternational Journal of Obesity, 2002doi:10.1038/sj.ijo.0801867 ↗
- Multiple Symmetric Lipomatosis: New Classification System Based on the Largest German Patient CohortPlastic and Reconstructive Surgery – Global Open, 2018doi:10.1097/GOX.0000000000001722 ↗
- Madelung’s Disease: Analysis of Clinical Characteristics, Fatty Mass Distribution, Comorbidities and Treatment of 54 Patients in ChinaDiabetes, Metabolic Syndrome and Obesity, 2022doi:10.2147/DMSO.S363836 ↗
- Madelung’s Disease: Revision of 59 Surgical CasesAesthetic Plastic Surgery, 2017doi:10.1007/s00266-016-0759-x ↗
- Madelung’s disease: comorbidities, fatty mass distribution, and response to treatment of 22 patientsAesthetic Plastic Surgery, 2013doi:10.1007/s00266-012-9874-5 ↗
- Differential clinical expression of multiple symmetric lipomatosis in men and womenInternational Journal of Obesity, 2003doi:10.1038/sj.ijo.0802427 ↗
- Sensory, motor, and autonomic neuropathy in patients with multiple symmetric lipomatosisMedicine (Baltimore), 1985doi:10.1097/00005792-198511000-00003 ↗
- MFN2-associated lipomatosis: Clinical spectrum and impact on adipose tissueJournal of Clinical Lipidology, 2018doi:10.1016/j.jacl.2018.07.009 ↗
- Madelung disease: distribution of cervical fat and preoperative findings at sonography, MR, and CTAJNR American Journal of Neuroradiology, 1998pubmed.ncbi.nlm.nih.gov/9576659 ↗
- Head and neck cancers associated with Madelung’s diseaseAnnals of Surgical Oncology, 1999doi:10.1007/s10434-999-0395-7 ↗
- Shortness of breathNHS, 2024nhs.uk/symptoms/shortness-of-breath ↗
- Dysphagia (swallowing problems)NHS, 2023nhs.uk/symptoms/swallowing-problems-dysphagia ↗
- Sleep apnoeaNHS, 2026nhs.uk/conditions/sleep-apnoea ↗
- LipomaNHS, 2023nhs.uk/conditions/lipoma ↗
- Alcohol-use disorderNHS, 2026nhs.uk/conditions/alcohol-use-disorder ↗
The figures on the page are from these sources.
Fat on the neck and shoulders
grows or interferes?
Send photos of the neck and shoulders and MRI if available. The doctor will say what needs to be examined and how the fatty masses can be removed.