Risks of Breast Augmentation for People Prone to Keloids?

I have keloid-prone skin and would like to have implants. Are there chances of hardening of breasts or having breast higher than normal? Do people who get keloids have more problems with breast implants? Do you have any suggestions?

Doctor Answers 19

Incision placement important for those who scar poorly

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There are two types of scar conditions which raise a red flag in cosmetic surgery and breast augmentation. Keloid formation is agressive scar that forms in an injured area of the skin and causes thick scar to form even beyond the point of the skin injury. Keloid scar is modulated by our genetic makeup, and those who develop keloid scar, or have the trait in their family often know. Keloids occur is specific areas, earlobe and jawline, back and deltoid or shoulder, lower breast and flank, and finally groin and pubis. Even in a patient who formss keloids, healing will occur normally in other locations of the body.

The second type of scar is hypertrophic scar, in which thick scar can form within the area of the skin incision and can be seen in all the keloid forming areas and more widely such as the abdomen and periareolar skin, and arms and legs. Hypertrophic scaring is seen commonly in patients of color, or asian decent.

Concerning breast augmentation in patients who form keloid or hypertrophic scars, healing on the skin level will not affect the implant or cause contracture. You have no greater risk of firmness or capsule contracture. Concerning the incision however, the preiareolar incision though not prone to keloid scaring can commonly become hypertrophic, especially in African Americans. You may be best to consider a transaxillary incision, or under the arm. The axillary skin has a very low rate of hypertrophic scar, and is not known to develop keloid scar either.

If you are programed to heal with a thick or raised scar the incision choice becomes important. Location can mean everything.

Best of luck,


Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Beware, no matter what the incision

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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!

Keloids and Breast Augmentation

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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.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Keloid prone skin and breast augmentation

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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.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

Keloids in breast augmentation patients

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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.  

Risk of keloid formation

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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

John J. Edney, MD
Omaha Plastic Surgeon
4.8 out of 5 stars 133 reviews

Keloid formation following breast augmentation...

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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.

Scarring after breast augmentation

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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

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Capsular contracture risk and keloid scarring are not related.

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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 

Mathew C. Mosher, MD
Vancouver Plastic Surgeon
4.5 out of 5 stars 34 reviews

Keloids, capsules, and breast implants

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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.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 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.