I Want to Get Breast Reduction but I Am Prone to Keloid

I am 20 years old, short, on the chubby side, with a bra size of 42DD but I feel that my breast are larger than that. They are quite saggy and have been since my earlier teen years. Could it just be fat? I want breast reduction but I tend to Keloid. I have keloid scars on my chest area and back from acne. I was told not to get tattoos because they might turn into scars but I have three that are keloid free. I've been experiencing spontaneous chest pains now and then...what should I do?

Doctor Answers 8

Breast Reduction Candidate?

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Thank you for the question.

You mentioned that you are “chubby”;  it will be in your best interest to reach a long-term stable weight prior to proceeding with breast reduction surgery.

The acne scarring that you have on your sternum does not necessarily indicate that you will have keloid scarring after breast reduction surgery. Some parts of the body are more prone to hypertrophic or keloid scar formation than others.

At some point, you will need to weigh the potential abnormal scarring associated with breast reduction surgery with the potential benefits of the procedure.

Best wishes.

Keloid scars

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Unfortunately, if you have a tendency to keloid after surgery, you will be prone after breast reduction surgery.  Discuss pre-opertively with your surgeon about post-operative scar managment.

Keloids and breast surgery

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If you definitely form keloids and not hypetrrophic scars, you more than likely will get keloids of your breast incisions.

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

Scars for Breast Reduction

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The biggest trade off that patients with symptomatic macromastia (large breasts) face is that of scars.  The question is whether the risk of scars, or of bad scars like keloids is more than the benefits you can get in terms of relief of back, neck and shoulder pain with a breast reduction.  There are also treatments that can be used if you develop keloids, so I would suggest you start with a consultation with a board certified plastic surgeon and then decide from there.

Breast reduction

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With a history of keloids, it is likely that you will have them; however, you must decide which one you would rather live with.  large breasts with all of the symptoms, or thick scars.  Incidentally, often they are not keloids but rather thick scars (hypertrophic).  Sometimes they are managed successfully with silicone gel sheeting for 3-6 months.

Shahin Javaheri, MD
San Francisco Plastic Surgeon
4.4 out of 5 stars 6 reviews

Breast reduction in a patient prone to keloid

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Tattooing done by simple needle injection should not scar and therefore is not an indicator of keloid-type scarring. Even someone who keloids from a scar in one area may not form a keloid-type scar in another part of the body but there is no way to know for sure, test for it, or control it. 

The minimum scar from a true breast reduction is a lollipop-type scar around the areola and down to the inframammary crease. Usually this area doesn't keloid but there is no guarantee. The worst keloid type scars in breast reduction are usually out on the ends of the anchor-type scar in the inframammary crease. 

The only alternative is liposuction of the breast which only involves one or two very small scars in the inframammary crease. This is not a true reduction as it only removes fat cells and will not lift the breast if it is sagging. It also gives an unpredictable amount of volume reduction and at most drops a cup size in very fatty type breasts. Weight gain or loss after liposuction of the breast is not a major factor though. One other issue is that there is no proof that liposuction of the breast has no influence on breast cancer risk late on in life. It's unlikely but there is no proof yet. 

Before considering the reduction and accepting the scar tradeoff, I would also make sure your weight is within ten pounds of where you expect it to stay. There are some things that can be done to minimize hypertrophic/keloid type scarring but nothing that is guaranteed. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

I Want to Get Breast Reduction but I Am Prone to Keloid

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I always tell any breast reduction patients that there is always some form of scarring. In your case I would guarantee it. A keloid former has a very high risk if not a high possibility of forming significant keloids in the breast reduction scars. Using tattoos might work. Posted photos of the breasts and tattoos would help. See in person a boarded surgeon in your area. From MIAMI Dr. Darryl J. Blinski, 305 598 0091

Options for breast reduction in individual with keloid scarring.

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With a history of significant keloid scarring, there is definite concern for unfavorable healing following reduction mammoplasty. Of course, weight gain and fatty accumulation may be contributing to the enlarged breasts and the simplest solution would be to get closer to your ideal body weight to assess the impact on the size of your breasts and symptom relief. However, it is more likely you will require surgery for a signficant size reduction. Alternatively you could consdier liposuction.

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