Revision for Keloid Scars After Breast Lift?

After 2 years you might need to have it removed, #ScarRevision, and then have optimal scar management to prevent it from becoming another #hypertrophicOrKeloidScar. 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: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.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”.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.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.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.

A raised scar is not uncommon after this type of surgery. There are multiple options for treatment, including injection of steroids to the scar on a monthly basis, silicone sheeting, topical medications such as scar guard, and laser therapy. Of course, there's also the possibility to revise the scar. You should return to the original surgeon, who advise you possible treatment plans.

Keloid and hypertrophic scars occur after breast lift or mastopexy.  Treatment includes topical creams, silicone pressure tabs, TAC injection and revisional surgery to reduce widening of the scars.
Keloids of the nipple and areola are a common complication after breast lift or mastopexy surgery.

Hi Janel,
Thank you for your question! While there is no satisfactory treatment, there are a few options to minimize the appearance of keloid scars.
Keloid scars can be treated by injecting a long-lasting cortisone into the scars. This should be done once a month. The keloid scar should become less noticeable and flatten withing three to six months after several injections.
Another newer treatment is to apply a silicone gel preparation over the scar and cover with an ace bandage or cloth wrap. You should keep it covered 12-24 hours a day and change the wrap every seven to ten days as needed.
Another form of this treatment is Neaclear Scar Advantage which contains Liquid Oxygen, cortisone, Vitamin E, and silicone. Just apply it like nail polish over the scar every day and in two to twelve months your scar will be flatter and smoother.
Last, surgery is an option. However, the scar can come back even bigger than before. You and your surgeon should monitor your scar closely. If it does happen to return, cortisone shots may be necessary to reduce the progression of the keloid.
Thanks again for your question. Have a great day!
Best regards,
Dr. Speron

I would agree with attempting non-surgical methods for 4-6 months (pressure therapy, massage, silicone gel sheeting, intralesional steroids, etc). If these fail to produce any significant improvement, I would attempt an initial scar revision on a small portion to the scar to make sure that this is not your normal response to injury.
If you heal well, I would proceed with total scar revision.

Raised and red scars are signs of immature scars. Pressure dressings or silicone sheeting can help with the hypertrophy and lasers can soften the color.

Keloids and hypertrophic scars (which is what I think you have) are treated in similar ways. The first thing you need to do is get get pressure dressings for the scars and these can be found on line. The second thing I would recommend is have your surgeon inject a small amount of steroid. I would do an initial injection then reevaluate in 4 weeks and inject if I need to.
The recurrence rate after surgical excision alone is very high so you want to avoid that initially. Other things that have been proven to help is radiation therapy and 5-FU a chemotherapy drug.
So see your surgeon and work on a plan.

Distinguish between hypertrophic scars (thick, raised, red) and keloids (scar grows beyond the area of injury). Silicone sheeting is a low cost, low risk treatment for hypertrophic scars. Try sheeting that is relatively think, self-adhesive, and with a fabric-type backing.

I would start with kenalog injections repeated every 6 weeks as needed.  I might try surgery after this if needed.  The problem with surgery is that the new scars may be worse than the old ones.
sek