i just went to my PS for my 6 months post op appt i love my results but i did have a little complain that i scar has become a little thick and bumpy and it really pulls and it feels like a stabbing pain he told me that i have devolved something called keloids and he would like to go in again and clean it out,a little lipo on my upper abs and than send me for 3 treatment of radiation i just wanted to know if that is normal that a doctor sends u to radiation for keloids i have never heard of it b4
6 Month Post Op Tummy Tuck Doctor Says I Developed a Keloid and Wants to Do a Revision and Radiation, is This Normal? (photo)
Doctor Answers (9)
Tummy tuck scars - laser therapy
These are not classic keloid scars. Another option is pulsed dye scar laser for your tummy tuck scars.
Radiation and keloids.
First things first, you appear to have hypertrophic scars. This is normal after a tummy tuck and is simply the result of excessive tension on the healing wound. Keloids are actual benign tumors which grow due to an uncontrolled inflammatory response. It is likely you've seen keloids before - most commonly from a simple ear piercing. The scar tissue can grow as large as a grapefruit off the earlobe. Treatment for actual keloids can include excision, pressure therapy, steroid injections, and less commonly - radiation. Radiating hypertrophic scars in my opinion would be unnecessary. A scar revision with aggressive scar management following revision is a good option.
Radiation is used to treat keloids after other forms of treatment failed
Radiation is not a totally benign treatment even though the dosage is very small. More importantly, in your case, I see nothing in the pictures you posted that would suggest you have a keloid scar. I would recommend having another board certified plastic surgeon actually examine you in person before you proceed with a 'keloid treatment'
Martin Jugenburg, MD, FRCSC
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From the photos it looks more like you have a widened scar (from tension) and hypertrophy but no keloid. I would agree with the scar revision but would not recommend the radiation therapy.
Keloids after surgery
It is hard to tell from your pictures but it looks to me more like hypertrophic scarring than true keloids. Hypertrophic scarring is not unusual after surgery and in my experience scars tend to look their worst (lumpiest, reddest, ugliest) at about 6-8 months after surgery. They can often get worse for a month or two before starting to flatten and fade. So I would not be in a hurry to do any sort of revision on my patients until at least 9-12 months post op. And yes, radiation is a treatment for keloids that can be very successful--but only as a last resort and only for true keloids which are symptomatic and limit daily activities (such as wearing clothing!).
As some of the other surgeons have mentioned your scars seem more consistent with hypertrophy. They appear as if they have widened as well. Strictly revising the scars with emphasis on postoperative scar massage and taping would be my first approach. Radiation is a very radical approach and is reserved for true keloid formation. Usually in the revision setting when the incision is on less tension, hypertrophic and/or wide scarring is less likely. I would recommend getting a second opinion by another plastic surgeon. Good Luck!
Concern with regard to abdominoplasty scar
The resolution of your photos are not great enough to fully discern the nature of your scars. However, they do appear to be more consistent with hypertrophic or just wide inflammed scars as opposed to keloids. Before you pursue any course of action, you may want to strongly consider seeing another plastic surgeon for a second opinion with regard to diagnosis and treatment. Radiation therapy is clearly a radical approach for your situation and in my opinion, highly unwarranted. Other options such as topical silicone gel, silicone sheeting and even steroid injections should be considered.
Keloid scars are a risk after any surgery.
Keloid scars are a risk after any surgery or trauma to the skin. Since a tummy tuck has a larger incision a keloid scar can be very noticeable
The diagnosis of a keloid scar is made when the scar begins to grow beyond the area of the initial incision or injury. It expands into normal tissue and frequently has a firm, irregular or abnormal shape. Keloid scars are treated with scar revision, steroid injections, pulsed-dye (and other) laser treatments, and as a last resort radiation treatments (usually in about that order).
A hypertrophic scar is a scar which is wider or more prominent than ideal, but it generally follows the same path as the original scar. It can also be slightly thickened and is frequently darker (red or brown etc) than normal. Hypertrophic scars are typically treated in the exact same way as keloid scars with the exception that radiation would never be indicated for a hypertrophic scar.
Based on your photos I would not diagnose you with a keloid scar, just a mildly hypertrophic scar.
Keloid in abdominoplasty scar
The photographs aren't close in enough to disclose whether you have a keloid or hypertrophic scar formation. Before any revisional surgery (since every incision and closure will carry the risk that it will keloid as well), I would recommend that you undergo a course of steroid injections. Therapeutic radiology for keloids was previously considered a reasonable adjuvant treatment; however, my consulting radiologists, from New York Hospital, have since stopped offering this based upon longterm risks.