What is the best incision if I'm prone to keloid scars and interested in getting a breast augmentation? (Photo)

Good morning!I find that the nipple incision heals almost invisibly by 12 weeks postop and has much less likelihood to form a hypertrophic scar when compared to a crease or armpit incision!

For keloid formers, there is not a way to prevent keloids.  In general, the longer the scar or the greater the number of scars, the greater the chance for keloids. 
The only way for sure to avoid keloids is to avoid making an incision. Though the likelihood for developing keloids is low, there is no way to predict their appearance after surgery.
In the broad array of literature as it relates to keloid treatment, there is a global absence of definitive protocols in the management of keloid scars. As an author of "Scars and Scar Revision in Reoperative Plastic and Reconstructive Surgery", I am well versed in the potential treatment options.  One treatment may be helpful for one patient while another treatment may help another patient.
Most fair-skinned patients heal the incisions well, and the scars are barely visible at one year.  However, some patients can develop widened scars, hyperpigmented scars, hypertrophic scars, or keloid scars.  These may require multiple modalities to achieve the best results. 

For a straight forward breast augmentation I would recommend an incision at the inframammary fold (IMF).  I would first recommend having a consultation with a board certified plastic surgeon.  You can discuss your options and preventative treatments postop, such as steroid injections.  In my practice, I recommend that my patients use a silicone based scar cream, such as Biocorneum for the first 6 months to a year.  Best of luck!

In my over 20 years of surgical experience, I have yet to see a keloid scar in the inframmary fold after straight forward breast augmentation. I would think that I would have seen a few by this time especially in patients of darker skin type. The inframamary fold incision is the incision associated with the least complications and a solid result. Make sure to see a board certified plastic surgeon. 

You have several options for scars when doing a breast augmentation.  The most common one is the one your surgeon suggested, which is at the inframammary fold.  This is usually the most straight forward way to insert a breast implant but you do end up with a scar on the breast.  An alternative is a peri-areolar incision, however, this has been associated with the highest rate of capsular contracture of all the incisions.  " The other option is through the axilla or armpit.  This is a great approach as there are no incisions or scars on the breasts.  The scar can be well hidden in a fold in the underarm, and once it's healed is very difficult to see.  Some surgeons utilize a "blind" technique where a blunt instrument is used to tear the insertion of the pectoralis major muscle.  However, this can lead to excessive bleeding and pain.  I recommend utilizing a direct visualization technique utilizing a camera so that the insertion of the pectoralis muscle can be divided using the cautery and the implant pocket precisely made.  The TUBA procedure is limited in that you can not utilize silicone implants.  

I would use the inframammary approach as it is not visible unless someone is under you looking up.  secondly, the scar which you show is not a keloid, so my guess is you will do ok.  good luck

Thank you for your question and photos. While keloid scar formation is indeed a possibility even with breast augmentation, this is in fact thankfully quite rare. If you were to develop a less than optimal scar the best location for it is in the inframammary fold underneath your breast since a scar in your armpit is more visible Since that is an exposed part of your body (sleeveless blouses or dresses, etc.)The scar in your wrist Is widened but not a keloid. A keloid or hypertrophic scar is thicker than your natural skin and looks like an earthworm or a sausage. There are technical tricks your plastic surgeon can use to help ensure that your scar heals as well as possible, but most plastic surgeons will probably end up recommending to you the approach beneath your breast in the inframammary fold. Do your research and make sure that your plastic surgeon shares your aesthetics, based on his or her Before and After gallery. Best of luck to you. 

Thank you for your question. As you know there are multiple incisions that can be used to place an implant. Most favor inframmary because it allows more precice placement and in a patien with some drop is often best hidden.The scar on your wris is not a keloid scar. Keloids grow beyond the boundry of the scar- like a golfball hanging off the earlobe after pierced ears. Hypertrophic scars are thick scars within the boundry f the scar. your scare does not look thick- it only looks wide. It is not surprising for a wrist scar to widen beacuse of wrist motion-- an inframmary scar is less likely to do that.Best wishes.

My opinion is the under the breast scar would be the correct choice if you have a breast augmentation. If you get a bad scar it would be most hidden in the breast fold. Also the natural pressure on this area from bra and weight of breast helps lessen chance of a poor scar. Good luck.

Dear RSProfile3398558,
I tend to prefer the periareolar incision because its the most well hidden. There is a natural border between the areola and the rest of the breast skin the hides the incision extremely well. You have to be completely naked to see it vs other incisions like transaxillary and inframammary are visible in clothing such as sleeveless shirts and bikini tops when extending your arms up. I've also noticed increased rates of bottoming out with inframmary incisions that is not reported. Transaxillary implants are always wide in appearance because the surgeon is not able to dissect medially enough to provide better cleavage. Ultimately, I can perform any of the incisions but I recommend the periareolar. There is no difference in sensation because the nerves that control nipple sensation come in laterally from the back and injury to them occurs when surgeons dissect to far laterally which is why transaxillary incisions have the highest nipple sensation disruption. There is no difference in breast feeding ability. One study did show a slight increase in capsular contracture with use of periareolar but that study was small and did not incorporate modern techniques such as below muscle placement, keller funnel usage and triple antibiotic irrigation. 
For scars, I close all of my incisions in 5 layers and do not use absorbable sutures because they cause inflammation and worse scarring. I tape all of my incisions in the office visits once a week for six weeks after surgery to improve the appearance. After taping, I start my patients on a scar gel therapy for 3 months that they have to put on their incisions twice daily.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery