Michael D. DePriest, MD, FACS

Thanks for the opportunity to evaluate your concern.  I see what appears to be a web across the sternum related to the pull of the breasts.  I imagine the weight of the breasts (particularly if there are implants) pulls against the relatively thin or weak skin and scar to create this condition.  I'm surprised it would be visible in a swimsuit or bra.  You may be much more aware of this than others.  A bra or swimsuit that gives more lift to the breasts may correct this without having to conceal the sternum itself.

If the condition persists in spite of better support under the breasts, I suspect the issue could be improved with a z-plasty, which is a rearrangement of skin to deepen the space between the breasts and to allow the skin to lie flat.  I would have some concern about the possibility of unfavorable scar in this critical area of the sternum, however.  You might have more visibility and awareness from the scar (particularly early on while it is red) than from the fold itself.   I would suggest that you ask a family member or trusted friend if he or she has ever noticed this fold as a reality check before considering a surgical solution.

I suggest making another appointment to see your doctor.  Perhaps one of the nurses could speak with you about your concern by phone as well.

4 months after your surgery, it is unlikely that there is any serious damage, but you should be checked.  Remember that total healing after a breast reduction takes 9-12 months.

In the meantime, I would recommend avoidance of any activities that induce pain.  Use of a good supportive bra all the time will be helpful, too.  Gentle exercise such as walking may be better than jogging while you are having pain or soreness.

You should discuss your concerns with your surgeon.  Your ethnicity, skin pigmentation and history of scar all indicate that you are correct to have some concerns.  Your surgeon may suggest use of a topical scar remedy such as a silicone gel product to go over the scar as it heals.  Pressure and frequent scar massage also help to minimize scar.  Certainly avoid sunlight or tanning on the healing scars.  

If in spite of the above measures you develop a scar problem, injections of steroids into the scar can allow them to settle down.  

Your plastic surgeon will have experience in dealing with scar problems, so he/she will be a good source of information in your particular instance.

I believe a good supportive bra is very helpful.  If the bra is now loose, I would suggest using one a bit more snug.  However, it should not be a painful process.   

Remember, total healing after surgery takes several months.

Either option could be correct!  The best approach is to see a Board-Certified plastic surgeon who will first talk to you about your reasons for wanting surgery.   In other words, what bothers you about your present condition?

If you are wanting to fit into clothes better, will you do better with the same size bust or perhaps smaller?  

Are you motivated for surgery because of neck or back strain?  In that case, I would suggest no implant.  

Is your goal to wear clothes without a supporting bra? In that case, I could not be sure that either option would be feasible over the long term because of the relentless effects of gravity and relative weakness of skin and supporting tissues.  

If your goal is to have more rounded, augmented-looking breasts with fullness in the upper half of the breast, an implant might be helpful.  

In general, combined reduction with simultaneous implant placement can be trickier than reduction alone.  Simultaneous reduction and implant surgery might be more likely to require touch-up surgery later.

Once again, your surgeon must first listen to your motivations for surgery before giving a plan for treatment.  

Best of luck!