Risks of Breast Augmentation for People Prone to Keloids?

Keloids are an uncontrolled growth of fibroblasts and collagen in the DERMAL layer of the skin. Because the areola has a modified dermal layer (very thin), it is very rare to have an areolar keloid. Similarly, because there is no dermis in the capsule it would be unlikely that you would have a higher rate of capsular contracture related to keloid formation.
Your risk should be the same as other typical surgical candidates. The other incisions such as the inframammary sulcus or axilla have standard dermal layers and would be at a higher risk of developing keloid scars.

Thank you for your question.  As a patient prone to forming keloids, you are not necessarily at any higher risk than anyone else for capsular contracture.  You are, however, at significant risk for developing keloids at your incision sites.  It is imperative that your surgeon be aware of this risk, and take proper precautions - meticulous incision closure, proper scar care, and likely the use of steroid injection at the incision site during the healing process.  

The pathophysiology of keloid formation is poorly understood
and, as a result, treatment of this problem can be very difficult.When keloids occur following surgery,
nonsurgical methods of treatment should be used first because surgical revision
is associated with a high recurrence rate.The
incidence of keloid formation following breast augmentation surgery is
extremely low.When patients have a
previous history of keloids in other locations, the incidence is slightly
increased but still very low.It’s
important to note that the rate of capsular contracture doesn’t appear to be
increased in patients with histories of keloid formation.A
variety of nonsurgical methods have been used to treat post-operative
keloids.These include massage, silicone
scar sheeting, pressure, steroid injections and rarely, radiation therapy.Despite the availability of multiple nonsurgical
treatments, keloids continue to have a high rate of recurrence.

I have performed breast augmentation on patients with active keloids and caution them to follow up regularly to prevent thickened scar formation on the areola and breast.  These patients have done extremely well with their breast implants.

It is normal to be concerned if you have had problems with surgical scars in the past. Unfortunately, your prior surgical scarring history often gives us no insight into your risk of developing breast implant capsular contractures. Having a consultation with a Plastic Surgeon can help to sort out whether you have had previous "keloid scarring" or the much more common process of  "hypertrophic scarring". Patients who have true "keloids" usually have a problem with all skin injuries - including piercings. Keloid forming patients will be at higher risk for a poor breast augmentation scar but are not a higher risk for an implant capsular contracture.

In my practice, a proactive approach to your breast surgery scarring will improve the chances of  having a very discreet scar from this surgery. Careful surgical technique and excellent aftercare can lower your risk of developing capsular contracture as well.

Dr. Mosher 

Your risk of capsular contracture is probably not any greater if you form keloids on the skin.
However every breast implant surgery has risk with it, including capsular contracture.
Breast augmentations usually involve a short incision, so with attention to the wound and expert technique, the usually low risk of an unsatisfactory scar may be a tolerable risk.

A tendency toward keloid formation should not effect the internal healing following breast augmentation. The risk for capsular contracture should not be increased and it should not affect the overall shaping of the breast. There is a higher likelihood however of an unsightly scar where the incision is made. Unfortunately when a keloid scar develops there is very little that can be done about it. You may want to reconsider your decision to have a breast augmentation if you have a tendency toward keloid formation. Good luck

Hello,

There is not a lot of good evidence to suggest that keloids in one area increases the problems of scarring with breast augmentation.  Keloids are part genetic but it is also environmental and location based.  Discuss this with your plastic surgeon and have him examine your past keloid history as sometimes there is a reason for bad scars other than our genetics and sometimes a keloid is not actually a keloid.

All the best,

Dr Repta

I know of no studies associating keloid formation with an increased rate of breast capsular contractures. I would be more concerned that you would form a keloid at the site of the implant incision.

If you truly have keloid skin, then you need to be aware that you can form them at any incision site, including the periareolar. A consultation with a board certified plastic surgeon will confirm whether or not you are truly a keloid former. Good luck!