Lipomas: When to Seek Treatment and Surgical Options

Sebaceous cyst related questions?

Hello Doctor, I have a sebaceous cyst on one side of my buttocks, approximately four centimeters in size (I'm not sure if that's considered large; it seems to have grown since I first noticed it several years ago).
It usually doesn't hurt (I don't feel it), and I previously thought it was just a pimple.
I only recently learned that it is a cyst, so I'm unsure if it can be felt when not inflamed.
However, sometimes it becomes inflamed, and it hurts a lot when sitting, but it usually resolves in a day or two (I haven't specifically tracked how often it becomes inflamed, but it seems to be every couple of months).
I would like to ask whether I should have it drained or undergo surgery? Will the surgery be performed in an operating room or as an outpatient procedure? Will I receive local, regional, or general anesthesia? Should I see a dermatologist or a plastic surgeon? After the surgery, will I be able to sit down? Will that put pressure on the wound? Thank you for your response and advice!

Niming, 20~29 year old female. Ask Date: 2023/05/27

Dr. Zhou Hongzhang reply Plastic Surgery

1.
If a tumor persists or enlarges after two weeks, surgical treatment should be considered.

2.
Whether to perform drainage or excision surgery should be determined through an outpatient consultation for a safer assessment.

3.
Generally, local anesthesia is used in plastic surgery.

4.
After the surgery, can I sit down? Will that put pressure on the wound? --- Yes, it will put pressure on the wound and may cause some pain.

Reply Date: 2023/05/27

More Info

Lipomas, commonly referred to as fatty tumors, are benign growths composed of adipose (fat) tissue. They are typically soft, movable, and painless, although they can become painful if they become inflamed or if they press against nearby nerves. In your case, you mentioned that you have a lipoma on your buttock that has grown to about four centimeters and has caused discomfort during episodes of inflammation.

When to Seek Treatment
While lipomas are generally harmless and often do not require treatment, there are specific circumstances where intervention may be warranted:
1. Pain or Discomfort: If the lipoma becomes painful, as you've experienced, it may be a sign that it is pressing on surrounding tissues or nerves. In such cases, treatment may be advisable to alleviate discomfort.

2. Size and Location: Lipomas that grow larger or are located in areas that cause cosmetic concerns or functional issues (like sitting) may also be candidates for removal.

3. Changes in Appearance: If the lipoma changes in size, shape, or color, it is essential to have it evaluated by a healthcare professional to rule out other conditions.

Treatment Options
The primary treatment for a lipoma is surgical removal, especially if it is symptomatic. Here are the options you might consider:
1. Surgical Excision: This is the most common method for removing a lipoma. The procedure can often be performed under local anesthesia in an outpatient setting. The surgeon will make an incision over the lipoma, remove it, and then close the incision with stitches.
2. Liposuction: In some cases, lipomas can be removed using liposuction, which involves using a thin tube to suction out the fatty tissue. This method may leave smaller scars but is not always suitable for larger or more fibrous lipomas.

Anesthesia Considerations
- Local Anesthesia: For smaller lipomas, local anesthesia is typically sufficient. You will be awake during the procedure, but the area will be numb.

- General Anesthesia: If the lipoma is large or if multiple lipomas are being removed, general anesthesia may be used, which means you will be asleep during the procedure.

Post-Operative Care
After surgery, you will need to follow specific care instructions:
- Sitting Post-Operatively: Depending on the location of the lipoma and the surgical technique used, you may be able to sit shortly after the procedure. However, it is essential to follow your surgeon's advice regarding movement and pressure on the surgical site to avoid complications.

- Pain Management: You may experience some discomfort post-surgery, which can usually be managed with over-the-counter pain relievers.

- Wound Care: Keeping the incision clean and dry is crucial for preventing infection. Your surgeon will provide specific instructions on how to care for the wound.

Specialist Consultation
For your situation, it would be advisable to consult with a dermatologist or a plastic surgeon. Dermatologists specialize in skin conditions and can perform minor surgical procedures, while plastic surgeons are skilled in cosmetic and reconstructive surgery and can handle larger or more complex lipomas.

Conclusion
In summary, while lipomas are generally benign and often do not require treatment, your symptoms suggest that it may be beneficial to seek surgical intervention. A consultation with a specialist will provide you with the best course of action tailored to your specific situation. Remember to discuss your concerns about anesthesia and post-operative care during your consultation to ensure you are fully informed and comfortable with the procedure.

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