Why haven't my scars healed after a year? (Photo)

I had breast englarment surgery over a year ago, my scars haven't healed properly and no idea why? I'm going in for scar revision surgery in January and hoping they healed better this time. Any idea why my scars haven't healed properly? My surgeon said it's not a keloid scar but unsure why they are the way they are.

Doctor Answers 16

Scar Management

Best Scar Management is important to minimize or completely hide from view, the telltale signs of your surgery—namely, scars. Both you and your surgeon want you to have the most minimal scarring possible. There are many possible causes for scars that are enlarged or not healing well. Unsightly scars are most commonly due to genetics, underlying medical conditions, or improper scar/wound care. The last part is very important and patients can make a noticeable difference in their scars’ appearance by following best scar management practices. Here are some simple tips.

Scar Management tips:
  1. Minimize tension on the scar. Steri-Strips and/or surgical tape are often placed in non-hair bearing areas at the time of surgery to minimize tension and keep pressure over the scar.  This minimizes the  stress that  can pull the scar apart (dehiscence) creating a wound and  delaying healing time, and can make the scar wider, or more “ropy”. In the first few weeks after surgery, I recommend the use of Embrace Scar Therapy which is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar.
  2. Keep your incision site/scar clean to prevent infection. Follow your surgeon’s wound care instructions to the letter with out modification. Never apply different products then recommended without first discussing them with your surgeon. This is especially important during the first few weeks. If there are any signs of infection, contact your surgeon’s office right away and/or see your doctor or his nurse immediately. Typical signs of infection may include redness outside the immediate incision site, asymmetric swelling, and drainage, of pus, fever, chills, and “feeling sick”.
  3. Protect your scars from the sun. Staying out of the sun is the best advice. Minimal exposure to sunlight is prevents hyperpigmentation (permanently turning brown) and other problems that can make the scar more noticeable. Sunscreen, at least 30 SPF and an overlying make camouflage make up additionally protects the scar from the suns harmful rays. This advice is especially important the first year following your surgery.
  4. Use specific scar maturation products recommended by your surgeon. Patients seem to have their own opinions on this touting everything from Pure Vit E, Coco butter, to Aloe Vera, etc but most have minimal benefit other than keeping the scar hydrated. Although hydration is important there are better, scientifically studied products with greater efficacy. Most of the scientific articles written about this subject indicate that topical silicone gel or silicone sheets work the best. The best product available in my opinion is the Embrace Scar Therapy System by Neodyne BioSciences, Inc. available in many surgeons’ offices. Essentially this is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar. For areas that are not applicable for this product (e.g. smaller areas or on the face), I prefer BioCorneum or Kelo-Cote products There are a lot of products to choose from, but silicone should be one of the key ingredients. Although Mederma, an onion extract derivative active ingredient rather than mainly silicone based may help, primarily silicone based products are better and many also contain other ingredients that may be synergistic (hydrocortisone or other steroid, Vitamin E, Sunscreen, etc).. If the reader has problems obtaining these they can call my office. Patient compliance is also critical – use often and according to directions or it will not work optimally. NEVER apply products without first discussing them with your surgeon.
  5. Monitor to make sure your scar is progressing optimally. Keep your scheduled follow-up appointments with your surgeon to verify that your scars are maturing as expected.  Occasionally if indicated you may need a topical steroid preparation or even a series of  injections (5-FU and/or Steroids) or laser treatments  to treat or  prevent scar hypertrophy or keloid formation (red raised scars), or other topical medicines to treat post inflammatory hyperpigmentation (brown scars) with prescription creams and possible laser treatments.

Orange County Plastic Surgeon
4.9 out of 5 stars 159 reviews

Scars after Surgery

Your scars have healed. Your body just over heals scars. This is called a hypertrophic scar.  Try using some silicone sheets daily and scar massage to help the color fade and to soften your scar. Some surgeons have lasers that will help the color fade. Good luck!

Ed Breazeale, Jr., MD
Knoxville Plastic Surgeon
4.5 out of 5 stars 15 reviews

Why haven't my scars healed?

Thanks for your question. Your scars are healed. One of them (left) appears to be what is called a 'hypertrophic' scar - or a scar that continued to stay inflamed longer than usual, resulting in a raised scar. The other other side (right) appears to be somewhat widened (because of some tension on the scar during the healing process). After a year, it's reasonable to consider a scar revision to get a better cosmetic result. This procedure entails cutting out the old scar and re-closing the skin in layers. Talk to your plastic surgeon or get a second opinion from a respected board certified plastic surgeon. Good luck. 

John L. Clayton, MD, PhD, MPH
Salt Lake City Plastic Surgeon
5.0 out of 5 stars 10 reviews

Hypertrophic Scars

Thank you for your question.  It appears as though you have what we call hypertrophic scars from your breast augmentation procedure.  Seeing as though you are a year out from surgery your scars have healed.  Scars take a year to reach full maturity and while they will evolve over this period of time, after a year has passed they are considered healed.  At this point a scar revision might be the best bet in the hopes of achieving more esthetically pleasing scars.  It is important that there is no tension on the closure of your incisions and that you discuss some post-surgical scar treatments with your operating surgeon to help promote good healing.  

Stephen T. Greenberg, MD
Woodbury Plastic Surgeon
3.9 out of 5 stars 59 reviews

Terms used for scar healing are sometimes confusing

While the exact term for how your scars have healed can be debated, the main thing for you is that they don't look good, and you want them to be improved while avoiding the chance that this will happen again.  They are now 1 year old, so they have in fact healed, and the healing is for the most part complete and mature.  I agree with your surgeon that they are not true keloids, insofar as keloid scars extend beyond the limits of the original injury.  Keloids would be huge, raised, thick, and growing onto normal skin adjacent to the actual incision site.  What you have are called "hypertrophic scars," and they also are "hyperpigmented," or darker than normal too.  This is sort of on the spectrum of wound healing, but technically and under the microscope, there is a difference between keloids and hypertrophic scars.  The significance of this for you is that people that form keloid scars get them due mostly to hereditary factors, and they are far more likely to have recurrent keloid scars with any subsequent injury, including surgical scar revision, whereas in cases of hypertrophic scarring like yours, there may be an excellent chance that it can be avoided or managed postoperatively with scar revision.  Scars can become hypertrophic for a variety of reasons, including genetic skin type or hereditary factors, sun exposure, amount of tension on the skin edges at wound closure, type of sutures used, suturing techniques used, precision with which the original incision was made and how it was placed, and postoperative forces on the healing scars.  Some of these things can be changed or managed with further treatment, and some can't. For instance, if we attempt surgical revision, we can modify our technique so that we make a properly oriented incision in the skin, close it meticulously and without too much tension, and then use things like silicone gel sheet afterwards.  We can also treat postoperatively with a special type of laser to prevent the scar from becoming hypertrophic.  This requires a very specific type of laser though, and the right expertise in using it, so not everyone has that available.  There are also some non-surgical measures that can be attempted before proceeding directly to surgical scar revision too.  There are medications including steroids and cell division inhibitors usually used to treat cancer but used in tiny doses for scars, like mitomycin C or 5 Flourouracil (5-FU), which can be injected into the scar directly, and they will often achieve very nice improvement without surgery, but again, they have to be used properly because they can cause some issues with the scars if incorrect dosing or technique are employed.  In the end, your surgeon knows what techniques were used for your first surgery, and therefore, they know where those techniques could possibly be altered this time around if surgical revision is attempted.  They will also know whether or not it is advisable to try a non-surgical option first before proceeding to surgery, as they are there to examine your scars in person.  You can discuss these things with your surgeon though so that you fully understand all of your options and where they stand on them.  Good luck. 

Joseph L. Grzeskiewicz, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 87 reviews

Too much tension

likely when your BA was performed, your skin was under a significant amount of tension from the newly placed implant. At 1 yr post-op, your skin should have relaxed and will heal with a better scar. Scars are a mix of little or no tension and your own bodies ability to heal. Good luck

Nathan Eberle, MD, DDS
Weston Physician
5.0 out of 5 stars 7 reviews

Why haven't my scars healed after a year? (Photo)

Thank you for your question. Hypertrophic scars can be difficult to treat. I recommend that you discuss various non-surgical treatment options such as scar hydration, massage, and silicone sheet therapy with your plastic surgeon at your next follow-up.

Wesley T. Myers, MD
Conroe Plastic Surgeon
5.0 out of 5 stars 5 reviews

Why haven't my scars healed after a year?

Your hypertrophic scars appear to have hyperpigmentation. This is something that is hard to control. Ask your surgeon about scar treatments after the revision (Silicone, lasers, etc)

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 70 reviews

Why haven't my scars healed after a year?

Thank you for sharing your question and photographs. Your scars have indeed healed, but in an exuberant manner, resulting in hypertrophic scarring.  This thickening of your scar tissue occurs due to a number of reasons including stretching and tension of the skin during healing, prolonged incision healing difficulties, suture dissolving issues, and inherent genetics.  Talk to your surgeon about your concern, they should be able to discuss with you the steps needed to minimize recurrence.  Best wishes.

Nelson Castillo, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 69 reviews

Breast Augmentation hypertrophic scars

Your scars are more visible than usual and I think you have been unlucky with the result of the scarring. I would consider that your scars have healed but the scarring may not have finished maturing. The left breast scar in particular appears to be or have been hypertrophic rather than keloid. Hypertrophic scars become red, widened, thick and itchy usually 6-12 weeks after surgery. They often get worse for a few months even 12-18 months and then slowly soften flatten and pale over 12-18 months or sometimes longer. Keloid scars tend to grow beyond the region of the original scar and are much more resistant to settling down. Unfortunately some people are prone to adverse types of scarring such as hypertrophic scarring. This often has more to do with your genetics than how the surgery was carried out.Revising the scar may well give the same result. Poor healing is a risk factor for hypertrophic scarring so if your wounds healed slowly or became infected last time then revision may produce a better scar on a second occasion. On a more positive note after a year the skin will have relaxed compared with when the implants were first put in. Increased tension across the wound is something that increases the tendency to make hypertrophic scars.

If you are having the scars revised I would advise you to treat the scar from early on with topical silicone gel.

Jeremy S. Hurren, BSc, MBBS, FRCS (Plast)
Chichester Plastic Surgeon
4.9 out of 5 stars 119 reviews

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.