Removing it is a whole operation in and of itself. See liposuction.
Any other surgery, they cut through it and do what they gotta do then sew the skin up. Most surgeries are laproscopic (keyhole) nowadays anyway. If they can do it that way, they will. Less bleeding, less scaring, less stitches.
It doesn’t just fall out of open surgery wounds if they do open you up. It’s attached lol
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