My Breast Augmentation Scars Are 1 Inch and 1/4 Inch Away from the Crease. Is This Normal?

The ideal inframammary incision placement is the subject of some debate. Although placement at the level of the inframammary fold would appear to make sense, this location has several potential problems. In some cases, these incisions can be irritated by the constant rubbing of underwire bras. In other cases, these incisions can be visible when women wear swimsuits that don't cover the fold area.In addition, decisions are sometimes made in the operating room to lower the inframammary fold. This occasionally results in a slightly higher incision. In most cases, these incisions heal nicely and the scars are almost imperceptible.At this point, you appear to have hypertrophic scars that should get better with time. A variety of maneuvers can be utilized to facilitate this process including silicone strips, topical scar agents and massage. It's not unusual for scars that look bad four months after surgery to be almost imperceptible twelve months following surgery.For these reasons, it's important to carefully discuss this issue with your plastic surgeon. Your surgeon should be able to formulate a treatment plan that, hopefully, minimizes your scarring.

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Thank you for your question.  It is normal for the incision to be near the fold, but not exactly in it.  Depending on the size of the implant, the breast fold may lower. To decrease the appearance of the scars, breast incisions can be managed using a multimodal approach:
1) Scar massage - starting as soon as the surgical dressings come off and the incisions are sealed
2) Silicone sheets or scar gels for about six months to year
3) Embrace - a tension reducing dressing for the first 2 months
4) Fractionated lasers to help blend the scar into the background - done as a series, starting about 4 weeks after surgery and repeated every four weeks for six months.
5) Sunscreen to prevent the scars from darkening

Inframammary incisions are sometimes asymmetric after breast implants because you may have had some pre-operative asymmetry.

Most likely your right breast fold was higher than the left and when the fold was lowered (which is normal) to match the other side the incision appears to be higher on that right side. 

Some of your asymmetry in inframammary scar position may be the result of pre-operative breast asymmetry.  In general, having the scars positioned slightly above the crease is preferable to in the crease, as bra straps and underwires rubbing on the scars can be very annoying, and two piece bathing suits can occasionally ride up slightly onto the breasts exposing the inframammary crease (and the scars if they are positioned in the crease). 

Your scars will likely improve in appearance over time, and as the breasts settle will probably not be visible when you look at your breasts from the front.  Once made, there is no practical way to significantly change their location.  I would recommend that you continue to take good care of your scars and follow up with your surgeon, so that you can optimize their final appearance.

Good luck.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You should continue to follow-up with your plastic surgeon in order to receive formal evaluations and maintain your doctor patient relationship.

When breast implants are inserted through the Inframammary crease (IMF) the incision site rides up with the added volume of the implant onto what will eventually settle out as the undersurface of the breast.  Although it impossible to exactly predict, the amount the incision will rise up can be estimated so the scar will lie closer to the newly created IMF.  However as other surgeons here have pointed out, often times this is purposely not done to avoid secondary complications such as bras or bathing suits rubbing on the scars, or  worse having a scar end up on the chest wall itself.

IMF scars will continue to fade and become less visible over the course of year on the undersurface of your breast.

If however in your specific case you do notice thickening of the scars as they do additionally look mildly hypertrophic- a small dose of kenalog and possibly some compression tape  may be warranted.

Warm Regards,

Dr Quinton Chivers

 

 

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If a patient selects an inframammary incision for placement of breast implants, it is reasonable for the scar to be above the inframammary fold.  More times than not, when an augmentation is performed the inframammary crease is lowered, the incision site is usually above the inframammary fold by about a 1/4 inch.  When the fold is dropped to accomodate the larger implant, the fold is lowered and therefore the distance between the incision site and the bottom of the breast increases by the amount the fold is lowered.  

it is often difficult to predict how much the fold needs to be lowered to accomodate the breast implant.  Most if not all breast augmentation scars heal beautifully.  What is hard for the patient to have patience.   The incisions usually heal marvelously.   I think I have only revised two breast augmentation incision scars in 19 years of clinical practice.

Usually the patients are overjoyed by the results of their surgery that the surgical incision is very unimportant.   But if the surgical scar is thick, unsightly or raised, it is not unreasonable to revise the scar.  I would wait at least 6 months before revising the scar.

Your scars are a little hypertrophic and the right one is a littel further from the fold. In my experience all augmentation scars in this area migrate away from the fold after surgery even if you make the incision right in the fold. Your scars and the breast result are within the realm of expected results from this type of surgery. The only additional thing you might do is have your surgeon inject the scars with a very small amount of kenalog and/or prescribe medicated tape. That will flatten and soften the scars.

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.

Sorry to hear you are unhappy with the scars. 

Placement of the scars varies with each surgeon.  Most surgeons would have  placed the scars a little closer to the inframammary fold (breast crease).  However, if the scar is right in the fold, then many patients get discomfort from their bras rubbing the scars (especially those with underwire).  Scars chronically irritated by bra friction wll get more inflamed and form thicker scars.  That's why some surgeons prefer to put the scars just off the fold.

The other possibiltiy is that the scars were originally closer to the fold, but the weight of the implants has stretched the skin near the fold and caused the scar to "migrate" up onto the breast.

If you are considering having a scar revision, I would recommend you continue keeping the scar moist with scar care products and the silicone sheeting you mentioned.  You may want to wait a full year because they will look better over time and it may save you more surgery.  If the scars are very wide, then time will not make them more narrow and you may want to have a revision sooner. 

Hope this helps!

I would recommend IPL or laser treatments to speed the process along.  The sooner the red fades the less concerned you will be.  Once they fade, the scars will hopefully be barely noticeable.  Their position above the fold will be much less of a concern.   Good luck.