I am an African American 7 months post op breast reduction. I have painful hypertrophic scars around the areola, as well as horrible scaring from where my plastic surgeon placed these plastic pins to guide him through the surgery. They came through my skin and had to be removed whenever they came to surface and out of the incision, otherwise it would be terribly painful. I also have healed with the marks of sutures. Am I candidate for revision? How soon can revision be determined?
Hypertrophic Scar Revision After Breast Reduction?
Doctor Answers 4
Proceed with caution and low expectations of scar revision
Unfortunately, treatment for hypertrophic scars in African-Americans is unpredictable at best.
In performing scar revisions, you have to ask yourself what characteristic of scarring you are trying to diminsh. You might want to try lower risk treatment, such as silicone sheeting, pressure, even small amounts of steroid injection if you are trying to soften and flatten the scar.
Scar revisions put additional skin tension on the wound often leading to repeat hypertrophic scars or spreading of the scars. Revison also usually lengthens the scar. I would suggest non-surgical treatment first and wait at least 1 or even two years for revision.
Time, silicon sheeting and steroid injections may help scars
The fact that your incisions are only 7 months old and that the scarring is hypertrophic is good news.There is some opportunity for spontaneous improvement since these scars are relatively fresh.
In addition, true hypertrophic scarring can sometimes be successfully treated with steroid injections and silicon sheeting.
I would rule out surgical scar revision until all else fails and realize that such surgery is associated with a high recurrence rate. The bottom line is that there may not be a solution for your scarring.
Revision of hypertrophic scars
Scar revision can sometimes be performed for bresat reduction scars. If they are keloidal they may need additional treatment with steroids, or silcone sheeting etc.. Hypertrophic scars can sometimes be revised and treated in a similar fashion.
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True keloids can be difficult and recurrent
It sounds as though your skin is very reactive to any trauma (such as a surgical incision). I'm not sure what you are referring to in regards pins for guidance but nonetheless you sound as though the smaller scars healed in the same way. The early treatment of keloids is hopefully avoiding them altogether but in spite of gentle tissue handling and careful closure, all plastic surgeons have encountered this problem at one time or another. Steroid injections directly into the scar can halp in addition to some form of silicone sheet pressure dressing. The steroid injections often require repeated treaments. I would not recommend any form of attempted scar revision until your current surgery has healed completely to decrease the tension on the healing incisions. Good luck to you.
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