Hypertrophic Breast Reduction Scarring

I had a breast reduction and suffered a pretty significant wound separation. Could this potentially be the reason for hypertropic scars?

Doctor Answers 12

Delayed healing after reduction can lead to hypertrophic scars

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Hypertrophic, or thick scars after breast reduction can have many causes such as age, ethnicity, presence of infection, tension during healing, delayed healing, or prolonged irritation or inflammation. An open area or wound separation can easily lead to a thickened or hypertrophic scar.

Once this process has been set in motion it can take a very long time for the scar to soften and improve, sometimes 12 to 24 months. If your surgeon feels the scar can be revised and improved, given a better environment to heal kindly, revision need not wait the one to two years and you may be better off. There is no harm in waiting however and you can also use scar massage or silicone sheeting to help speed the process.

Best of luck,


Hypertrophic Scars and Treatment

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Yes, wound separation along with a lot of other factors such as genetics, age, race, certain medications,tension on the skin closure, less than optimal scar treatment and other factors can contribute to hypertrophic scars. 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:
  1. 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.
  2. 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”.
  3. 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.
  4. 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.
  5. 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.   #hypertrophicscars #keloids #preventingbadscars

Breast Reduction and Scarring?

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Thank you for the question.

If the “hypertrophic scar” is occurring in the location of the previous wounds separation that is likely related. These scars can often be improved with scar revision surgery.

Best wishes.

Wound separation likely cause of hypertrophic scar from breast reduction

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Absolutely, a wound separation is a common cause of a hypertrophic scar. Once it is healed and the overall swelling is resolved, a scar revision is likely to result in improved appearance.

Hypertrophic scars with breast reduction

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Absolutely, this is the cause of hypertrophic scarring.  If the wound was left to heal by secondary intention, hypertrophic scars will form.  I would provide you with a specific protocol for scar revision and improvement.

Wound healing problems can lead to unsightly scars after breast reduction.

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Most breast reduction scars become very acceptable over time (months).  If there has been a wound healing problem, this might not be the eventuality.  A scar revision will be required which is not a big operation but does restart the whole healing process for the area that is corrected.

Scarring after breast reduction

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Scarring after a breast reduction surgery is typically very acceptable. The breast skin in the lower portion of the breast is very forgiving to scarring. However, if you had wound separation, the scars may be thicker than normal. In this case, it is possible that you may be candidate for a scar revision surgery that will excise this wide scar and replace it with a thinner one. 

Breast wound scar quality

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Based on your description, you won't have a fine-line scar on your breasts. You may end up with a widended scar that is fairly flat, or a thickened scar- much of this depends on your own scar biology. Scars can always be revised in the future- usually 12 months or longer after surgery.

Scar revision may be necessary

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If that is the way they formed a scar revision might be in order. This is not a common issue with well closed breast reduction scars.

Best Regards.

John P. Di Saia, MD
Orange Plastic Surgeon

Wound separation causes hypertrophic scarring after breast reduction.

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Wound separation and delayed healing can certainly cause thick scars after breast reduction.

We have seen this occasionally in our New York City practice, and the scars can usually be improved a lot with scar revision under local anesthesia.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

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.