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What is the removal of a lump or bump?
This is the surgical removal of a lump in the skin, such as a mole or epidermal cyst or of the fat that lies just beneath it – e.g. a lipoma.
Usually, this procedure can be performed under local anaesthetic. This means you will be awake for the procedure. Sometimes, larger lesions require a general anaesthetic.
The surgeon will remove the lump and send the specimen for analysis. The wound will be closed with some stitches, and the type of stitch will vary depending on the type of lump that is removed. Sometimes these are dissolvable and sometimes they will require removal.
Why are lumps and bumps usually removed?
Benign conditions may cause symptoms like itching or bleeding. Occasionally, they will catch on clothes or prevent hair brushing if located on the scalp. Patients may also have them removed because of cosmetic problems.
If any lump is growing in size or shape, or if there is some doubt as to the exact diagnosis, your doctor may recommend removing the lump to confirm the diagnosis by looking at it under a microscope. This is known as an excision biopsy.
What are the benefits of removing a lump or bump?
The main benefit is that the diagnosis is confirmed and that your symptoms are treated. There may also be a benefit in reducing the likelihood of future complications or recurrence of the same problem. For example, sebaceous cysts can become infected intermittently.
What are the risks of lump and bump removal?
This is a safe procedure and the likelihood is that you will make a good recovery. However, all surgical procedures have some risks.
1. Scars: Scars always result from surgical cuts and all surgery leaves scars. Your surgeon will do their best to prevent this by hiding the incision in a skin crease wherever possible, and by using dissolvable stiches or glue. Occasionally a red lumpy, thickened and itchy scar may result. This can be disfiguring. This occurs in some patients whose skin heals in a specific fashion, known as Hypertrophy. Keloid is a separate condition which is more commonly found in Afro-Caribbean patients.
2. Infection: If this happens the wound will become red and painful, and you may have a temperature. You should seek further help from your doctor as you may require antibiotics. If you smoke, you have diabetes or you are obese you are at an increased risk of wound infection.
3. Bleeding: If this happens, it typically causes a haematoma (a collection of blood) in the tissues. It increases the appearance of bruising. Swelling can slow down healing and it may spoil the cosmetic appearance of the final result. A large bleed is unlikely to occur but very rarely it may require a return to the operating room. Bleeding is more common if you have been taking blood thinning drugs such as Warfarin, Asprin, Clopidogrel (Plavix or Iscover) or Dipyridamole (Persantin or Asasantin).
4. Fluid: fluid may build up under the skin, which is known as a seroma. This fluid fills the space of the lump that was excised and sometimes this may need removal.
The lab test may show that the diseased area or lump has not been completely removed. If there is any disease left behind, further surgery may be needed to cut the rest out.
What are the alternatives to having lumps and bumps removed?
Some skin conditions can be safely managed without surgery, and your doctor will advise you if this is the case. For some specific skin conditions it may be possible to apply a topical cream that helps. However, this will not treat conditions such as a lipoma or a sebaceous cyst.
What is recovery like?
If you have surgery at OneWelbeck you will go home on the same day. If you have had a procedure under local anaesthetic you will be able to leave straight away. If you have had a general anaesthetic you will need to rest until the effects have passed (usually a few hours). If you have had a general anaesthetic you will also need to arrange for someone to escort you home. Try to have a friend or relative with you for the first 24 hours after your surgery.
You may need pain relief to help with any discomfort as the anaesthetic wears off. Pain after this operation is very low, usually controllable within a day or two with medication you can buy over the counter, such as simple paracetamol and ibuprofen.
Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice. Your surgeon may give you a short supply of stronger painkillers when you’re discharged from hospital along with other medicines, such as laxatives, anti-inflammatories and occasionally medicines to protect your stomach lining from the stress of surgery and the side effects of the anti-inflammatories. These will be issued with instructions.
If there is any doubt as to the nature of the tissue removed then the sample will be sent to the laboratory for analysis to ensure there is no malignancy. It may take a week or so for the results of the biopsy to be ready. A follow-up appointment, to give you the results, may be arranged before you go home.
Frequently Asked Questions
1. What do I need to do before surgery?
If you smoke, you will need to stop as this increases your risk of getting a chest and wound infection, which can slow your recovery. Stay as active as you can. If you are having a general anaesthetic please stop eating or drinking anything except for water for six hours before your surgery and stop drinking water two hours before your surgery. If you are having local anaesthetic, you can eat and drink as normal.
2. What will happen when I am admitted for surgery?
When you arrive at hospital, the nurse will check your heart rate, blood pressure and test your urine. You will be asked to put on a gown and to wear compression stockings to help prevent blood clots forming in the veins in your legs.
Your doctor will complete the consent process started in the clinic, by signing, or re-signing, with you the Consent Form. The doctor will discuss with you what will happen before, during and after your procedure.
3. How should I care for my wound?
Your wounds will be covered by a water proof dressing. Wear this dressing in the shower (not the bath, which will soak them off) for the first week. At the end of the first week, remove them and place them in a bin.
Underneath you may see flaky, crusty substance, often purplish in colour. This is glue. It is waterproof. Don’t actively remove it, simply leave it but continue to shower (not bathe) for another week. Slowly it will flake and fall off. If it hasn’t by 14 days, then gently peel it off in the shower or wash it off. At 14 days you can return to swimming and bathing and the wounds will be completely healed. There are no stitches to remove – these are hidden in your body and your body dissolves them over time.
4. When should my sutures be removed?
This will depend on the type of sutures that have been used. If stitches have been inserted into your wound that are not dissolvable then these will need to be removed either at you own GP surgery or the Hospital Outpatient Department. The timings will depend on the site of body that has had treatment and the type of suture, but it is usually at 14 days. If this is to be done at the GP Surgery you will be given a letter that summarises the details of your operation and suggests a date when you should make an appointment to see the Practise Nurse who will remove the stitches. Alternatively, you may be given an appointment to attend the Outpatients at One Welbeck to have the stitches removed and the wound checked by the doctor.
5. When can I drive or use machinery?
General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. There is no exact timing restriction on your driving. You must be able to perform an emergency stop and be free of any physical restrictions due to your operation, be comfortable in the driving position and be able to safely control your car. Broadly speaking, you will most likely need to refrain from driving for at least a week and often closer to ten days. You should be free from the distracting effect of pain or the sedative or other effects of any pain relief medication you are taking. You should inform your motor insurer of your operation so that you’re aware of their recommendations and any restrictions.
6. When can I return to normal activity levels?
Following minor surgery you may need to refrain from any exercise for two weeks. After this point the wound will be well healed. This includes swimming, gym work, running or strenuous gardening. Your surgeon will usually review you around 2-3 weeks after the surgery and will then allow a graduated return to activity, initially avoiding heavy lifting and very strenuous activity for a further two weeks. By four to six weeks post operatively, you can do whatever you wish, including high intensity training, weight training and vigorous cardiovascular activity.
7. When can I go back to work?
If you have a desk job or work from home then whenever you are able to manage this is up to you. If you do more manual work or have to travel a lot then most people take one week off work.
8. When can I fly?
If you have had local anaesthesis, this can be done straight away. For a general anaesthetic, then you can fly 2-3 days after your surgery as long as it was uncomplicated and you feel comfortable to travel. It does depend slightly where you are going, and on individual patient factors.
9. What should I eat and drink after the operation?
Eat sensibly as the anaesthesia, painkillers and surgery may make you feel slightly nauseated – so have small light meals. Avoid rich, spicy or fatty foods and alcohol for 48 hours after the surgery but after this you should be able to return to a normal diet.