Most soft lumps under the skin are harmless lipomas or cysts and come out easily under local anaesthetic. A few are not, and the job of the consultation is to tell those apart before anything is cut.
Lipomas, sebaceous cysts and dermoid cysts are removed through a small incision under local anaesthetic, taking the whole lump with its capsule so it does not recur. Most need no imaging. A lump that is deep to muscle, larger than about five centimetres, growing quickly, painful or fixed needs an ultrasound or MRI before excision, because those features can indicate a sarcoma.
A lipoma is a benign collection of fat cells in a thin capsule. It is soft, mobile, usually painless and grows very slowly. A sebaceous or epidermoid cyst sits in the skin itself, often with a small central punctum, and contains keratin that smells characteristic if it discharges. A dermoid cyst is present from birth and sits at a line where the face fused in development, commonly at the outer eyebrow.
All three are removed the same way in principle: an incision along a natural skin line, the lump dissected out complete with its capsule, and the wound closed in layers. Taking the capsule matters, because a remnant left behind regenerates the lump.
The important part is deciding which lumps this applies to. Certain features raise the possibility of a soft tissue sarcoma and should prompt imaging before any attempt at removal. A lump deeper than the fascia, one bigger than about five centimetres, one that is growing noticeably, or one that is painful or fixed to deeper tissue all belong in that group. Cutting into a sarcoma in the belief it is a lipoma makes the eventual treatment considerably harder, so the threshold for a scan is deliberately low.
A dermoid near the midline of the face or over the scalp is a separate caution: it can extend inward, and those are imaged before surgery too.
Almost everyone with a straightforward lump. The exceptions are the ones worth taking seriously.
The lump is examined for size, depth, mobility and consistency. Imaging is arranged where any concerning feature is present.
The incision is planned along a natural skin crease or tension line and local anaesthetic infiltrated around, not into, the lump.
A cut long enough to deliver the lump intact. Forcing a large lipoma through a short incision tears the capsule and invites recurrence.
The lump is freed with its capsule complete. For a cyst, the punctum is excised in continuity with the sac.
Dead space is closed in layers so a cavity does not fill with fluid, and the skin closed to give the finest scar the site allows.
Everything removed goes to the laboratory, however obviously benign it appeared.
Mild soreness managed with simple painkillers. Keep the dressing dry. Some bruising is normal.
Wound checked, stitches removed at seven to fourteen days depending on the site. Back to most activities.
Wound fully healed. Begin scar massage and silicone if advised. Histology result discussed.
Scar matures and fades. Scars on the back and shoulder take longest and may widen.
A lump removed with its capsule rarely returns. There will be a scar, and its length is roughly related to the size of the lump, because a large lipoma cannot be delivered through a tiny incision without tearing the capsule. Scars on the back, chest and shoulder tend to stretch more than elsewhere and this is discussed beforehand. An infected cyst removed while inflamed has a higher recurrence rate, which is why drainage first and excision later is usually advised.
Small procedures with proportionate risks, plus one that matters for the rarer diagnoses.
Straightforward wound care, with scar management once healed.
Liposuction can reduce some lipomas but leaves the capsule behind, and they commonly recur. Complete removal needs an incision long enough to deliver the lump intact.
Most soft lumps are harmless. But depth, size, rate of growth, pain and fixity matter more than softness, and any of those warrants a scan first.
Excising through infected inflamed tissue has a higher recurrence rate and a higher chance of wound problems. Drainage first, definitive removal once quiet, works better.
Everything removed is examined. The occasional surprise is exactly why.
The two things that go wrong with lump removal are recurrence from a retained capsule and, much more seriously, operating on a sarcoma that was assumed to be a lipoma. Both are avoided by assessing properly first rather than reaching for the scalpel.
Removal of a symptomatic, enlarging or repeatedly infected lump is commonly covered by health insurance. Removal purely for appearance often is not. Imaging, where needed, is an additional cost. A written estimate follows assessment.
Almost always starting with whether it is dangerous.
Ask your question →Most are not. The features that raise concern are a lump that is deep rather than just under the skin, larger than about five centimetres, growing noticeably, painful, or fixed to deeper tissue. Any of those means a scan before any attempt to remove it.
Rarely, if the capsule was taken whole. Recurrence almost always means a fragment was left behind, which is why the incision has to be long enough to deliver the lump intact.
No. Any removal leaves a scar, and its length relates to the size of the lump. What can be controlled is where the scar sits and how it is closed, which is why incisions are planned along natural skin lines.
Usually better not. Operating through inflamed tissue makes complete removal of the sac harder and recurrence more likely. Drainage relieves the acute problem and excision follows once things are quiet.
Usually where the lump is symptomatic, enlarging or repeatedly infected. Removal purely because you dislike the look of it often is not, and that is made clear in the estimate.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
