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Sebaceous Cyst Removal

Dr Thng Yongxian

Hepatopancreatobiliary & General Surgeon
MBBS • MMed • MRCS (IRE) • FRCSED • FAMS

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What Are Sebaceous Cysts?

Sebaceous cysts are non-cancerous, slow-growing bumps beneath the skin, commonly resulting from the blockage of sebaceous glands. These glands secrete sebum, an oily substance that lubricates the skin and hair. Cysts can develop due to trauma, swollen hair follicles, or high testosterone, causing the gland to become swollen and clogged.

 

Symptoms typically include a visible lump, skin redness, and occasional pain or tenderness, especially if the cyst is infected. While usually not harmful, these cysts can become uncomfortable or aesthetically bothersome.

Sebaceous Cyst Removal Procedures

Sebaceous cyst removal can be performed using various techniques tailored to the cyst’s characteristics and the patient’s needs. Here’s a detailed look at the primary methods:

Surgical Excision

Surgical excision is a medical approach used for removing sebaceous cysts. This procedure involves the complete removal of the cyst along with its encapsulating sac to ensure it does not return. It is ideal for larger or recurrent cysts and is performed under local anaesthesia.

 

Step-by-Step Procedure for Surgical Excision

  1. Preparation and Anaesthesia Administration
    The patient is prepared for surgery, which includes cleaning the skin over the cyst. Local anaesthesia is administered around the area of the cyst to ensure the patient is pain-free during the procedure.

  2. Making the Incision
    A single incision is made directly over the cyst to expose it and its surrounding tissue. The size of the incision depends on the size of the cyst.

  3. Dissecting the Cyst
    The surgeon carefully dissects the cyst from the surrounding tissues. Special care is taken to maintain the integrity of the cyst sac to avoid spillage of its contents, which could lead to inflammation.

  4. Cyst Removal
    Once the cyst is fully dissected, it is removed in its entirety, including the encapsulating sac. This step is crucial to prevent recurrence.

  5. Checking for Complete Removal
    The surgical site is thoroughly examined to ensure no remnants of the cyst or sac are left behind. Any bleeding is controlled, and the area is cleaned.

  6. Closure of the Incision
    The incision is closed with sutures. These sutures may be dissolvable or might require removal after healing, depending on the size of the incision.

  7. Dressing and Bandaging
    A sterile dressing is applied to the incision site to protect it against infection and to absorb any minor bleeding that might occur during recovery.

  8. Postoperative Instructions
    The patient is given detailed instructions on how to care for the incision site, on signs of infection to watch out for, and when to return for a follow-up or suture removal.

Minimal Excision

Minimal excision reduces scarring compared to full excision while attempting to remove the cyst sac to prevent recurrence. This technique involves a smaller incision, which means less healing time and reduced scarring but has a slightly higher risk of the cyst returning compared to complete excision.

 

Step-by-Step Procedure for Minimal Excision

  1. Preparation and Anaesthesia Administration
    The patient is prepared for the procedure by having the skin cleaned around the cyst area. Local anaesthesia is administered to numb the site and ensure comfort throughout the procedure.

  2. Making a Small Incision
    A smaller incision than that used in full excision is made directly over the cyst. The incision is just large enough to access and remove the cyst sac with minimal tissue disruption.

  3. Dissecting and Removing the Cyst
    Using specialised instruments, the cyst is carefully dissected away from the surrounding tissues. Efforts are made to keep the cyst sac intact and remove it entirely to minimise the risk of recurrence.

  4. Cyst Sac Removal
    The cyst sac is gently teased out through the small incision. This step requires precision to ensure complete removal of the sac without rupture.

  5. Closure of the Incision
    The incision is closed with fine sutures, enhancing cosmetic outcomes and reducing scarring. Sutures used are often absorbable, depending on the size of the incision and the surgeon’s preference.

  6. Dressing the Site
    A sterile, small dressing is applied to the incision site to keep it clean and protected.

  7. Postoperative Care
    Patients are instructed on how to care for the wound, what signs of infection to look for, and when to contact the surgeon if issues arise.

Pre-Procedure Considerations

Before undergoing sebaceous cyst removal, several important steps and considerations must be addressed to ensure the procedure is safe and effective. Here are the key pre-procedure considerations:

  • Medical Evaluation
    A thorough medical evaluation determines the most appropriate method for cyst removal. This includes assessing the cyst’s size, location, and any signs of infection. Any allergies, medical conditions, or medications that might affect the procedure should be mentioned.
  • Infection Control
    If the cyst is infected, antibiotics may be necessary before removal. An infected cyst often requires drainage rather than immediate excision to manage the infection first.

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Recovery and Aftercare Following Sebaceous Cyst Removal

Recovery following sebaceous cyst removal is usually straightforward, with patients typically resuming normal activities shortly after the procedure. Here are key aspects of aftercare to ensure a smooth recovery:

  • Wound Care
    Keep the surgical site clean and dry. Change dressings as recommended to prevent infection.
  • Activity Restrictions
    Avoid strenuous activities and excessive movement that may stress the surgical site for the first few days after the procedure to prevent reopening the wound.
  • Pain Management
    Over-the-counter pain relievers can be used to manage any discomfort following the procedure. If pain persists or worsens, seek immediate medical attention.
  • Monitoring for Complications
    Watch for signs of infection, such as increased redness, swelling, pus, or unusual pain at the incision site. Fever may also indicate an infection.
  • Follow-Up Visits
    Attend follow-up appointments to ensure the site is healing properly and to address any concerns. These visits are also important for removing stitches if they are not self-dissolving.

When To Seek Treatment For Sebaceous Cysts

Treatment for sebaceous cysts should be considered if the cyst becomes painful, inflamed, or infected, which can manifest as redness, swelling, and drainage of pus. Additionally, seek medical advice if the cyst rapidly grows or interferes with daily activities due to its size or location.

 

Aesthetic concerns or discomfort caused by the cyst’s presence are valid reasons for seeking treatment. Early evaluation can prevent complications and determine the most appropriate intervention to manage the cyst effectively.

Dr Thng Yongxian

Senior Consultant

HEPATOPANCREATOBILIARY & GENERAL SURGEON

MBBS (SG) • MMed (Surg) • MRCS (Ire) • FRCSEd (Gen) • FAMS (Surg)

Dr Thng Yongxian is a dual fellowship-trained Hepatopancreatobiliary & General Surgeon who has performed over 6000 surgical procedures.

  • Bachelor of Medicine & Bachelor of Surgery
  • National University of Singapore
  • Membership of the Royal College of Surgeons, Ireland
  • Master of Medicine, General Surgery, Singapore
  • Fellow of the Royal College of Surgeons, Edinburgh
  • Fellow of the Academy of Medicine, Singapore

He pursued his subspecialty training in Hepatopancreatobiliary surgery first in the Department of Hepatopancreatobiliary Surgery, Singapore General Hospital. Following this, he completed a clinical fellowship in Minimally Invasive Hepatopancreatobiliary Surgery at Seoul National University Hospital in Bundang, South Korea.


Dr Thng set up and pioneered the Minimally invasive surgery program for his hospital in complex liver and pancreas cases. His surgeries were featured on live national television. His surgical videos have also been presented at international surgical conferences. He also pioneered the use of capsule colonoscopy for colorectal screening.


Dr Thng has served on various committees at hospital, cluster and ministry level. Dr Thng served as a member of the Ministry of Health (MOH) Laparoscopic cholecystectomy Clinician workgroup for value-driven care (VDC).

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