Risks of Breast Augmentation for People Prone to Keloids?

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.

Thank you for your question.  As a patient prone to forming keloids, you are not necessarily at any higher risk than anyone else for capsular contracture.  You are, however, at significant risk for developing keloids at your incision sites.  It is imperative that your surgeon be aware of this risk, and take proper precautions - meticulous incision closure, proper scar care, and likely the use of steroid injection at the incision site during the healing process.  

The pathophysiology of keloid formation is poorly understood
and, as a result, treatment of this problem can be very difficult.When keloids occur following surgery,
nonsurgical methods of treatment should be used first because surgical revision
is associated with a high recurrence rate.The
incidence of keloid formation following breast augmentation surgery is
extremely low.When patients have a
previous history of keloids in other locations, the incidence is slightly
increased but still very low.It’s
important to note that the rate of capsular contracture doesn’t appear to be
increased in patients with histories of keloid formation.A
variety of nonsurgical methods have been used to treat post-operative
keloids.These include massage, silicone
scar sheeting, pressure, steroid injections and rarely, radiation therapy.Despite the availability of multiple nonsurgical
treatments, keloids continue to have a high rate of recurrence.

I have performed breast augmentation on patients with active keloids and caution them to follow up regularly to prevent thickened scar formation on the areola and breast.  These patients have done extremely well with their breast implants.

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.

Dr. Mosher