Soft or firmer lumps under the skin are very common, and are usually harmless If they are bothersome or worrying to the patient, however, they can be removed.
Subcutaneous lumps are a very common condition that can be treated by a plastic surgeon. They can appear on any part of the body for no particular reason. Fatty lumps rarely go away on their own, but can be surgically removed if desired. These are most commonly benign soft tissue tumours, but may nonetheless cause the person irritation, concern or cosmetic problems. The most common kinds of lump are lipoma, which is a benign fatty tumour, and atheroma, also called an epidermal cyst or sebaceous cyst.
Such localised changes in the subcutaneous tissue can almost always be removed if desired, but it is rarely a medical necessity.
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Risk factors include sudden changes and large size of the lump
Although most subcutaneous lumps are harmless, some can be malignant tumours. It is advisable to seek treatment without delay if there are sudden changes in the lump, or if it is large. It is important to contact a doctor immediately if:
- a lump has just appeared or has started to grow rapidly
- the lump is more than 5 cm in diameter
- the lump seems to be deeper than just immediately under the skin
In these cases, the doctor will examine the skin change and refer the person for further tests if necessary.
Lipoma removal begins with a consultation with a plastic surgeon
The clinical pathway starts once an appointment is booked with a plastic surgeon. The initial visit involves an examination of the affected area and a discussion of the person’s wishes and goals for treatment. The outcome of the visit is a personalised care plan, which will then be followed as agreed. If an operation is planned, its cost and the recovery time will also be made clear in the initial consultation.
In the case of a single small skin change, it can be removed without a prior assessment visit based on prior information. When booking an appointment, the person should explain their situation and indicate whether they wish to have the lipoma removed at the first visit. The final assessment is made by the doctor, however, and in most cases a separate appointment is made for the procedure.
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Imaging is seldom needed
In some cases, the doctor may come to the conclusion that the subcutaneous change should be examined more closely before planning its removal. Imaging usually involves an ultrasound scan to determine the size and depth of the lump, as well as its relationship to the surrounding structures and any abnormal blood flow. This measure is taken quite rarely, and in most cases the lump can be removed on the basis of a consultation.
Surgery performed according to the person’s wishes
Whether they appear on the lower limbs, body or upper limbs, superficial lumps of varying degrees of firmness and subcutaneous tissue changes are treated in the same way. Depending on the size and location of the problem, surgery can be performed under either local or general anaesthetic. General anaesthetic is an option that is always available. The duration of the procedure depends on the size of the affected area, and usually takes from half an hour to two hours.
Aftercare usually does not require any special measures or follow-up examinations. The removed tumour is routinely sent for pathological examination to confirm that it was not malignant. The results of the examination will be available two weeks after the operation, and will be sent to the patient as agreed.
The duration of sick leave, if the person requires it, depends largely on the size and location of the operated area. The doctor can estimate the duration of sick leave in advance during the consultation. The doctor will give you specific personal instructions for stitch removal, exercise and washing of the affected area.
The end result is usually inconspicuous
The cosmetic result of removing lumps is usually extremely good. The subcutaneous lump will usually have stretched the skin, allowing the skin to be stitched to close the wound during surgery without any need for grafts. The scars are usually quite inconspicuous, and minimising them is part of the plastic surgeon’s expertise.
The surgeon will plan the incisions according to the lines of the skin and close the wound in layers, allowing the skin to heal naturally. Aftercare of the scar is an essential part of ensuring the best possible outcome. It may include massage of the scarred area, applying ointment to it, and in some cases applying silicone tape. The goal is always to achieve the most inconspicuous scar possible, without functional impairment.
