Breast Augmentation Incision Scars Too Low

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars.

Best,
Dr. Karamanoukian
Realself100 Surgeon

This requires a physical examination to determine if it's the scar itself or the placement of the implant. In either case, you may need surgery to correct it.

Hello! Thank you for the question!  The typical incision used for breast augmentation are: inframammary (in the fold beneath your breast), periareolar (at the border of the areola), axillary (within the armpit crease), and TUBA (through the umbilicus). Incision placement will do a lot with your preference, surgeon comfort level with that approach, and the type of implant - silicone implants will be difficult to place within certain access incisions. Breast augmentation scars are well concealed and are very discrete. They should not be visible within clothing, and likely hidden without clothing. If your concern is the visibility without garments, you should consider remote access incisions such as in the armpit. However, these other incisions heal very well on the breast and often times inconspicuous.  I would await at least a year for your final results/scarring to show.  It typically takes at least 6-12 weeks for the swelling to subside and implants to settle to their final position.It is common for scars to fully mature for up to a year. In the meantime, there are a few things that may help to ameliorate your incision/scar. The most proven (as well as cheapest) modality is simple scar massage. Applying pressure and massaging the well-healed scar has been shown to improve the appearance as it breaks up the scar tissue, hopefully producing the finest scar as possible. Other things that have been shown to add some benefit, albeit controversial, are silicone sheets, hydration, and topical steroids. In addition, avoidance of direct sunlight to the incision will significantly help the appearance as they tend to discolor with UV light during the healing process.  If unsightly scars are still present after approximately a year's time, other things that your surgeon may consider are intralesional steroid injections, laser, or just surgical revision of the scar itself.Consult with a plastic surgeon your goals, concerns, and expectations. Certainly incisions should be considered, but should not limit your overall result by hindering visualization and access to your surgeon, and what produces the best results in his/her hands.  Hope that this helps! Best wishes!

IF your implants are too high, you could undergo bilateral lower pole capsulotomy to lower the implants and bring them to the level of the incisions. IF they are relatively short scars, excising them in a larger pointed ellipse with thoracoepigastric skin advancement and fixation to the chest wall could also help elevate the scars but they may be longer. Expansion and excision is possible but not advised.

Is the breast augmentation scar too low, or perhaps the bottom of the implant too high?  Your surgeon's scar placement may have anticipated a degree of gravitational descent of the implant that has not materialized.

This is a difficult fix.  The one good thing is that in the life of scars, this is still early.  Scars may evolve and even become worse for the first six month.  It is only after approximately 18 months that color fades and scars become more refined.  Give it more time.  There are few options with changing placement once the incision is in place.  If the scar is hypertrophic (thick), the best treatment is silicone sheets applied over the scar.  Good luck!

The final location of the breast implant incision in the inframammary fold may change with time.  Some are at the fold, some are above the fold, and some are below the fold.

The position of the scar is usually placed at or just above the inframammary fold of the breast. If the fold is too low, either it was placed there, or the fold has risen. This can happen in cases of capsular contracture or in total submuscular augmentation. If there is a capsular contracture, the treatment is to correct the contracture and properly set the fold. If the implant is in good position and the scar is simply too low, I recommend waiting at least 12 months to 2 years. Correction usually involves lowering the fold, so if the scar fades adequately, this is the best option.

Dear Jo123

First, go back to your doc and share your concern. If the distance from the scar to the areola is too great on the low side, the doc may try a small excision of skin above the scar. It may help.

Dr R Sadove

The first thing to determine is if the implants are in the right position.  If they are, then this is basically a technical error on the part of the doctor most likely.  If the implants re too high then lowering them may get them down to the crease level.  Ideally the scars should never be below the breasts, either in the crease or just barely above it.