Can You Safely Undergo Surgery for Cysts with Hypertrophic Scarring?

The issues related to surgery for sebaceous cysts and fistulous tracts associated with keloids?

Due to a recurring hard lump near the anus that was painful, the doctor was uncertain if it was a fistula.
After being prescribed antibiotics, a few months later, another lump appeared that looked like a sebaceous cyst.
The doctor mentioned that surgery would confirm whether there is a fistula.
I came across discussions about people having sebaceous cysts in the genital area and inquired about keloids (hypertrophic scars), but I didn't find any results.
I realized that I also have a tendency to develop keloids.
My main question is whether someone with a keloid tendency can undergo this surgery (for a sebaceous cyst, uncertain if it's a fistula).
I previously asked a friend with a keloid tendency, and she said she had surgery for hemorrhoids without developing keloids, but my situation seems a bit different.
Thank you, doctor.

An, 40~49 year old female. Ask Date: 2023/12/08

Dr. Ke Fangxu reply Surgery

A sebaceous cyst, also known as an epidermoid cyst, can occur in any skin area where sebaceous glands are present.
Keloids, on the other hand, are a rare condition characterized by the uncontrolled proliferation of scar tissue.
More commonly, hypertrophic scars refer to scars that become enlarged and raised.
The occurrence of scar hypertrophy is related to the location of the wound and whether it has been subjected to irritation.
Common areas for keloid formation include the joints, shoulders, and chest.
Infections and friction can also contribute to scar hypertrophy.
Generally, wounds around the anal area do not easily develop hypertrophic scars unless there are repeated infections.

Reply Date: 2023/12/08

More Info

When considering surgery for cysts, especially in the context of hypertrophic scarring (keloids), it is essential to weigh the risks and benefits carefully. Hypertrophic scarring is a condition where the body produces excess collagen during the healing process, leading to raised scars that can be itchy, painful, or unsightly. Individuals with a history of keloids or hypertrophic scars may be at a higher risk for developing similar scars after surgical procedures.

In your case, the cyst near the anal region, which has been painful and recurrent, raises concerns about whether it is a simple sebaceous cyst or potentially a more complicated condition such as a fistula. The surgical approach to these conditions often involves excision, which can provide definitive treatment and relief from symptoms. However, the presence of a keloid-prone skin type necessitates a more cautious approach.

1. Surgical Considerations: If you have a history of keloids, it is crucial to inform your surgeon. They may take extra precautions, such as using specific surgical techniques or post-operative care strategies to minimize the risk of keloid formation. For example, they might recommend using silicone gel sheets or pressure dressings post-surgery, which can help flatten scars.

2. Timing of Surgery: The timing of surgery can also be a factor. If the cyst is inflamed or infected, it may be advisable to treat the inflammation first before proceeding with surgery. This approach can help reduce the risk of complications and improve healing outcomes.

3. Alternative Treatments: If surgery is deemed too risky due to your keloid-prone nature, there may be alternative treatments available. For example, some cysts can be treated with corticosteroid injections, which can reduce inflammation and may help shrink the cyst. However, this is not a definitive solution and may not be suitable for all types of cysts.

4. Post-operative Care: After surgery, diligent post-operative care is essential. This includes keeping the surgical site clean, monitoring for signs of infection, and following your surgeon's instructions regarding activity restrictions and wound care. If you notice any signs of abnormal scarring, such as excessive redness, itching, or raised areas, you should contact your healthcare provider promptly.

5. Consultation with a Specialist: Given your history of keloids, it may be beneficial to consult with a dermatologist or a plastic surgeon who specializes in scar management. They can provide tailored advice and may suggest pre-operative treatments that can help minimize the risk of keloid formation.

In summary, while it is possible to undergo surgery for cysts even with a history of hypertrophic scarring, careful planning and communication with your healthcare team are vital. Discuss your concerns openly with your surgeon, and consider seeking a second opinion if you feel uncertain about the proposed surgical approach. The goal is to ensure that you receive the best possible care while minimizing the risk of complications related to your skin type.

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