What's the Best Treatment for Keloid Scar Post-BA? (Photos)

Currently 4 months post-op from BA with incision under breast 2months post-op, the scars started to grow in size (now the thickness and length of fore finger), they're itchy as hell, and are flaking. GP last month said they're keloid (never had before) - prescribed me steroid cream to apply for one week which helped but now I'm just massaging natural Rosehip oil twice daily - should I see a skin specialist for further advice or is there something I can buy online to help e.g. silicone strips?

Doctor Answers 5

Thickened Scar Inframammary Fold - How Do I Treat It?

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The good news is, you don't have a keloid.  A keloid is a scar that goes outside the bounds of the incision, the way that bread moves outside and over the edge of a pan after baking.  Your scar is just a scar.  It's a little thickened at points, which would then be called a hydrotropic scar, but in no way is it a keloid.  Please stop using the steroids as they break down the collagen in the scar and cause the scar to spread, which would definitely be a negative and difficult to cure without surgery.

Silicone sheeting is certainly very popular.  However, steri strips are cheaper and accomplish the same mission.  The problem is that your new collagen is coming into this wound having no thick skin over the scar area, and therefore the collagen comes in with whirls and swirls instead of flat.  By putting steri strips or even just a soft paper tape on it will flatten the scar by causing pressure and also teaching the collagen to come in parallel to the tape.  

Wearing a bra continuously takes tension off the breast, therefore allowing the dynamic red scar to flatten out and gain a mature white appearance.  A bra that has a shelf in it that would also push on the bottom of the breast, plus steri strips, would be the best suggestion.  Leave the steri strips on as long as possible.  Removing them too soon would start tearing your skin from the glue in the steri strips.   

Breast augmentation scar

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You have a hypertrophic scar with some surrounding hyperpigmentation. It is not a keloid and there is no evidence of skin flaking in the photos. It is impossible to say what the best treatment is based solely on the photos and limited history in your post.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Keloid post breast augmentation

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Hi there,

It's hard to be sure but the second picture looks more like hyperpigmentation than a keloid. I think the scar within the area of hyperpigmentation looks pretty normal. 

It's hard to give you good advice on this without better pictures.  I suggest post some better resolution pictures, and see your plastic surgeon  - just call for an appointment, they will be keen to see, advise and treat you as part of normal follow up.

If you had the surgery overseas, the lack of access to your surgeon is one of the limitations in making that choice. 


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I am having some trouble looking at the photos to see if the scar is just wide or if it is also raised.

The reason I raise this is that if it is only wide, the issue is that the scar has too much pigment, and the best treatment may be a bleaching agent, usually 4% hydroquinone. In the US that requires a prescription.

If it is elevated, it would be considered a hypertrophic scar, a word sometimes used interchangeably with keloid, and the treatment would be geared to discouraging the overgrowth of the healing tissue. Silicone strips are a good first step, requiring no doctor visit. There are scar creams carried by most large pharmacies. The "gold standard" has been injections with steroid, usually kenalog, which a physician usually does. 

Starting with something you can do without a physician makes sense, unless as I note it is not raised.

Thanks for your question, and best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Treatment of a Keloid Scar

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While a picture is not as good as an in-person evaluation, it appears that your scarring process is actually a hypertrophic scar. Although similarly formed by excessive scarring, hypertrophic scars stay within the confines of the incision while keloids tend to invade the surrounding normal skin. Keloids tend to be very resistant to any treatment used.

A hypertrophic scar is much more amenable to treatment. Your first line of treatment should be massage and application of a silicone sheet. We are unsure as to how this  treatment works, but it is effective and would try this before moving on to steroid injection. The steroids tend to work, but they come with a potential price. They can cause thinning of the skin, formation of small blood vessels in the skin known as telangiectasia and can even cause changes in skin pigment.

You also appear to have an area of increased pigment surrounding the scar. This is most likely due to the ongoing inflammation and might improve on it's own in time. While you can use bleaching creams to lighten the area, you must apply them every day and it will take at least 6 weeks to see any results. If you stop the medication the pigment will return almost immediately.

The initial non-invasive treatments may resolve your problem and are certainly worth a try. I would advise for you to follow up with your plastic surgeon so that he may further advise and help monitor your scar's progression. 

I hope this helps. Good Luck.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.