Removing a Lipoma and Other Cysts

Lumps, Bumps, and Removal

Finding a lump is scary. Even the coolest cucumbers have a hard time with the emotions that come up. Just recently, a well-known TV personality opened up about discovering a lump, navigating the stress of imaging, and ultimately choosing to have it operated on. But not every lump spells bad news.

Her story, like so many others, reminds us that while the experience can be unsettling, the outcome isn’t always dire. Many lumps turn out to be completely harmless and can be easily surgically removed. Hopefully, the following few paragraphs will help you stay calm if you find one, and give you some peace of mind on tackling them.

Types of Benign Lumps

Benign means the growth is non-cancerous, doesn’t invade nearby tissue, and typically grows slowly or stays the same size. Malignant refers to cancerous growths that can invade surrounding tissue, spread to other parts of the body, and often develop more aggressively. We are only talking about benign bumps here. Malignancy is a whole different can of worms.

While not exhaustive, this list highlights some of the more commonly encountered lumps and bumps. Surgery is a standard option for treatment, especially when there’s pain, infection, or cosmetic concern. Removal is usually a straightforward procedure for general surgeons and is performed with a referral from a primary care provider or specialist.

• Lipomas are soft, rubbery lumps made of fat tissue just under the skin. They can appear almost anywhere on the body, are slow-growing, and don’t turn into cancer. They’re usually painless unless pressing on a nerve or joint. This soft-tissue lump is one of the most frequently diagnosed and can be surgically removed if it becomes bothersome.
• Epidermoid cysts, otherwise known as sebaceous cysts, are firm lumps just under the skin that are filled with keratin (a soft, white protein) – despite the nickname, they don’t come from oil glands. They are slow-growing and non-cancerous, though they can get inflamed or infected. They’re usually on the face, neck, and trunk, and surgery may be recommended if the cyst is painful, has ruptured, or is cosmetically bothersome. There is a caveat to this: In the spirit of transparency, some studies have shown that, in extremely rare cases, they may exhibit signs of malignancy.
• Pilar Cysts, or Trichilemmal Cysts, are round, smooth bumps that can form in clusters around hair follicles, usually on the scalp. They can be genetic and rarely cause symptoms, although they can grow larger over time. They’re relatively common in middle-aged adults, and surgical removal is simple.
• Pilonidal cysts develop near the tailbone, can look like small pits or dimples, and may become swollen or drain fluid. They are not cancerous, but they can easily become infected, especially if they collect bacteria or debris. Moderately common, they are especially prevalent in younger adults and those who spend a lot of time sitting or have coarse body hair. Surgical drainage may be necessary during an infection, but complete surgical excision is often required to prevent recurrence.
• Ganglion cysts are fluid-filled lumps that usually appear near joints or tendons, most often on the wrist, hand, ankle, or foot. They aren’t harmful, but they can press on nearby nerves and become quite uncomfortable. When this happens, or if it limits movement, they may be drained, but surgery is a good option if the cyst is painful or keeps recurring.
• Dermoid cysts contain skin structures like hair and oil glands – sometimes even teeth! Though unusual, they aren’t that rare. They’re considered congenital, discovered early in life, typically appear around the face and back, and do not go away on their own. Surgical removal is the best option.
• Fibromas are lumps made up of fibrous (connective) tissue, often found just under the skin or in soft tissues. They can appear anywhere on the body, and surgery is done if they are painful, growing, or for cosmetic reasons. Otherwise, they may be left alone.
• Adenomas are benign tumors in glandular tissue, as in the salivary glands, thyroid, or breast tissue, and how often they show up depends on where they are. Oftentimes, they’re monitored unless they grow or cause symptoms, and surgery is performed if they’re causing issues or there is uncertainty about diagnosis.
• A Baker’s cyst is a swelling filled with built-up joint fluid that forms behind the knee, often related to arthritis, injury, or other joint problems. While quite common, surgery is reserved for persistent, painful cysts that don’t respond to other treatments.

Surgery for Removal

Benign soft tissue lumps, such as lipomas and cysts, are commonly removed using minor surgical procedures and are often performed in an outpatient setting under local anesthesia. While removal is typically straightforward, the approach can vary depending on the type of lump, its location on the body, and whether it’s accompanied by inflammation or infection. For example, removing a small lipoma from the forearm is a very different experience from excising a pilonidal cyst from the lower back. The size, depth, and nearby structures all play a role in how the surgeon approaches it.

This is what to expect, in general:

• Anesthesia: A Local anesthetic is used to numb the area. In cases involving larger lesions or sensitive areas, sedation or general anesthesia may be considered.
• Incision and dissection: A small incision is made directly over or adjacent to the lump. The surrounding tissue is gently separated to expose the mass, which is then removed.
• Removal: For lipomas, the fatty tissue is dissected and removed in one piece. For cysts, the key is to remove the entire cyst wall or capsule. If the cyst is ruptured or inflamed, this can be more challenging and may require delayed excision after initial drainage and control of inflammation.
• Closure: The wound is typically closed with sutures, depending on depth and location, and in layers to promote healing and minimize scarring.
  When an infection is present, immediate surgery may be avoided to drain fluid or pus first, then return later for a more complete removal. Additionally, the surgical technique may be adjusted to accommodate anatomical considerations. For example, some areas of the body may require shaving, or a wider excision may be necessary to accommodate the anatomy or avoid injury.

No matter the type, the goal is the same: to remove the lump cleanly and minimize the chance it will come back. Most people go home the same day and recover quickly, with minimal downtime.

When in Doubt, Check it Out

Anytime you notice a new lump or bump on your body, it’s best to have it checked by your primary care provider or a specialist. Once you’ve gotten the go-ahead and you’ve made the decision to move forward with removal, Dr. Chang can perform the surgical procedure safely and effectively. He specializes in straightforward outpatient removal of lipomas, cysts, and other soft tissue masses.