Knot/lump forming on internal dissolvable suture?

Question

I noticed a lump behind my incision (you can only feel it, not see it) and it is about the size and feel of a jelly bean. I am 6 weeks post op. Inframmamary incision. My surgeon examined me and said it is most likely some scar tissue around an internal stitch that is refusing to dissolve. Will it go away? Could this be a sign that I will get capsular contracture, since it’s my immune system’s doing? I hate massaging it as it makes me feel nauseous but I’m trying my best.

Orna Fisher, MD · Answer

What you are describing is a normal phenomenon and may or may not completely resolve over time. If it is directly behind the scar there’s really nothing to do. Scarred tissues do not always become as soft as unscarred tissues, especially not early on. That being said, scarred tissues are also only ever 70% as strong as tissue that was never cut in the first place. Therefore some mild thickening in the area is not necessarily a bad thing. I would not recommend doing anything to it, not even massage. Any scar needs to be given a whole year before the changes due to remodeling slow down or stop completely. 
It has nothing to do with the potential for a capsular contracture, so don’t worry about that. 
Of course, this advice would be different if that little lump becomes soft/mushy, if the overlying skin becomes red, or if it starts to drain.

Daniel Barrett, MD · Answer

Dear mcalawso,
I understand your concern. However, without a proper assessment it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment. Only after thorough examination you can get proper recommendations and advice. In most cases, surgeon needs to remove the stitch that causes problem.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Chad Robbins, MD · Answer

Hello and thank you for your question .  This is not unusual, if it is a knot on a stitch it will dissolve or make it's way out.  If it's scar tissue, it should over time , soften and flatten.  This will not a factor with regard to capsular contracture.

David E. Berman, MD (retired) · Answer

it is not uncommon to get some scarring or thickening around an internal suture as it dissolves. it will almost certainly get softer over the course of a year (you need to be patient). This does not mean that there is anything wrong with your immune system! it also does not mean that you will get problems with capsule formation. i have done lots of BA and I am very puzzled why, massaging your own breast scar incision, should cause you to be so emotional upset that you get nauseated? i think you can force yourself do this twice daily for 1-2 minutes (eg when taking a shower) and it will probably speed up the scarring getting softer. however, even if you don't do this, it will gradually improve with time (think months, not days).david berman md

Knot/lump forming on internal dissolvable suture?

Answers (4)