I have keloid-prone skin and would like to have implants. Are there chances of hardening of breasts or having breast higher than normal? Do people who get keloids have more problems with breast implants? Do you have any suggestions?
Risks of Breast Augmentation for People Prone to Keloids?
Doctor Answers (16)
Keloids and Breast Augmentation
Keloids are an uncontrolled growth of fibroblasts and collagen in the DERMAL layer of the skin. Because the areola has a modified dermal layer (very thin), it is very rare to have an areolar keloid. Similarly, because there is no dermis in the capsule it would be unlikely that you would have a higher rate of capsular contracture related to keloid formation.
Your risk should be the same as other typical surgical candidates. The other incisions such as the inframammary sulcus or axilla have standard dermal layers and would be at a higher risk of developing keloid scars.
Keloid prone skin and breast augmentation
Your risk of capsular contracture is probably not any greater if you form keloids on the skin.
However every breast implant surgery has risk with it, including capsular contracture.
Breast augmentations usually involve a short incision, so with attention to the wound and expert technique, the usually low risk of an unsatisfactory scar may be a tolerable risk.
Scarring after breast augmentation
There is not a lot of good evidence to suggest that keloids in one area increases the problems of scarring with breast augmentation. Keloids are part genetic but it is also environmental and location based. Discuss this with your plastic surgeon and have him examine your past keloid history as sometimes there is a reason for bad scars other than our genetics and sometimes a keloid is not actually a keloid.
All the best,
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Capsular contracture risk and keloid scarring are not related.
It is normal to be concerned if you have had problems with surgical scars in the past. Unfortunately, your prior surgical scarring history often gives us no insight into your risk of developing breast implant capsular contractures. Having a consultation with a Plastic Surgeon can help to sort out whether you have had previous "keloid scarring" or the much more common process of "hypertrophic scarring". Patients who have true "keloids" usually have a problem with all skin injuries - including piercings. Keloid forming patients will be at higher risk for a poor breast augmentation scar but are not a higher risk for an implant capsular contracture.
In my practice, a proactive approach to your breast surgery scarring will improve the chances of having a very discreet scar from this surgery. Careful surgical technique and excellent aftercare can lower your risk of developing capsular contracture as well.
Keloids, capsules, and breast implants
I know of no studies associating keloid formation with an increased rate of breast capsular contractures. I would be more concerned that you would form a keloid at the site of the implant incision.
Beware, no matter what the incision
If you truly have keloid skin, then you need to be aware that you can form them at any incision site, including the periareolar. A consultation with a board certified plastic surgeon will confirm whether or not you are truly a keloid former. Good luck!
Incision placement important for those who scar poorly
There are two types of scar conditions which raise a red flag in cosmetic surgery and breast augmentation. Keloid formation is agressive scar that forms in an injured area of the skin and causes thick scar to form even beyond the point of the skin injury. Keloid scar is modulated by our genetic makeup, and those who develop keloid scar, or have the trait in their family often know. Keloids occur is specific areas, earlobe and jawline, back and deltoid or shoulder, lower breast and flank, and finally groin and pubis. Even in a patient who formss keloids, healing will occur normally in other locations of the body.
The second type of scar is hypertrophic scar, in which thick scar can form within the area of the skin incision and can be seen in all the keloid forming areas and more widely such as the abdomen and periareolar skin, and arms and legs. Hypertrophic scaring is seen commonly in patients of color, or asian decent.
Concerning breast augmentation in patients who form keloid or hypertrophic scars, healing on the skin level will not affect the implant or cause contracture. You have no greater risk of firmness or capsule contracture. Concerning the incision however, the preiareolar incision though not prone to keloid scaring can commonly become hypertrophic, especially in African Americans. You may be best to consider a transaxillary incision, or under the arm. The axillary skin has a very low rate of hypertrophic scar, and is not known to develop keloid scar either.
If you are programed to heal with a thick or raised scar the incision choice becomes important. Location can mean everything.
Best of luck,
Keloids: maybe, Contracture: no
Seriously: Treating a patient that is keloid prone is an extra challenge for the surgeon. Surgeons don't have much control over how your body heals the incision. A routine, carefully repaired wound usually heals well. If you formed a permanent, enlarged, raised, hard, purple or pink ridge wherever your skin was injured every time, no matter how minor the injury, you are probably going to get such a scar if you have breast augmentation. You may or may not consider this serious enough to avoid breast enlargement.
As far as contracture or displacement of the implants is concerned, I have not seen an increased risk of this in my patients. I am not aware of any association between these events.
You can have breast augmentation done through the nipples.
Hi! Keloid formers do NOT have an increased risk of problems with breast augmentation other than the possibility of a skin keloid in the surgical scar.
Sexual skin (the nipple and areola, the scrotum, etc.) heals with much less scarring than regular skin. We actually don't know why this is so.
Of course there are no guarantees, but I have done a number of breast augmentations through the areolas in keloid formers, who went on to heal with very good scars.
Consider a periareolar incision
In our experience, patients with keloids have not had a significant increase in capsular contracture. However, anywhere a skin incision is made, you are at higher risk for a skin keloid. We have had good luck with a periareolar incision for patients with keloids.
In the one case it did become thickened, the appearance was masked by the color transition between the skin and the areola itself. Discuss with your surgeon ahead of time what methods of minimizing your risk are available to you and exactly when postop you can begin to treat your scar. Good luck.