How do you avoid hyperpigmentation after breast lift and augmentation? Is there any way I can minimize the hyperpigmentation?

Question

I am a 21 year old African American woman and am looking into receiving a breast lift with implants. I scar very dark even after minor trauma to the skin (a small pimple) and it stays dark and discolored after months. Realistically, what should I expect in terms of scarring from a lift? Is there any way I can minimize the hyperpigmentation that would more than likely occur?

Gary M. Horndeski, MD · Answer

The best way for African American women to avoid unattractive scars is to avoid the vertical scars associated with the traditional techniques.  The technique I recommend is The Bellesoma Method.  This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation and the ability to breast feed are maintained.  At the same time or later, fat transfers can be performed if additional volume is desired.  The incisions are hidden at the areola skin junction and in or near the inframammary fold.  Implants are not lifetime devices and half are removed by 9.5 years.Best Wishes,Gary Horndeski, M.D.

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented  scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Daniel Barrett, MD · Answer

Hi UnbotheredXx,
  
For scars, I close all of my incisions in 5 layers and do not use absorbable sutures because they cause inflammation and worse scarring. I tape all of my incisions in the office visits once a week for six weeks after surgery to improve the appearance. After taping, I start my patients on a scar gel therapy for 3 months that they have to put on their incisions twice daily.
  
I understand you are concerned with the appearance of your scars. As your scars heal, it should flatten out and lighten. Loss of pigmentation or hyperpigmentation may also be experienced but will resolve over time. Always follow your surgeon's post operative care instructions when it comes to scar management to avoid any complications like infection and for faster healing and recovery.
  
If you are concerned, you should visit your plastic surgeon for assessment and to discuss your concerns, as different surgeons have different approaches in scar management. Your surgeon can also advice you of new innovations that can help with managing and improving the appearance of scars like lasers and other scar treatment modalities.
  
Daniel Barrett, MD, MHA, MS
  
Certified, American Board of Plastic Surgery
  
Member, American Society of Plastic Surgery
  
Member, American Society of Aesthetic Plastic Surgery

Michele A. Shermak, MD · Answer

Hello!First, limiting the size of the implants limits tension on wound closure and that helps with healing and scar outcomes. Intentional wound closures should have better outcome than say a traumatic injury healing. I would work closely with your plastic surgeon on scar management strategies. Check with your surgeon also on outcomes he/she has had with women of color. As long as you are eager for size/contour changes of the breast, you should be happy.

Donovan Rosas, MD · Answer

Given time, scars fade. In the early post operative period scar massage, sun protection and silicone sheeting as well as topicals can be helpful. Once stabilized (up to 12 months), one can explore light/laser therapy to address pigmented scars. As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Jeffrey Antimarino, MD, FACS · Answer

Thank you for your inquiry.    In short, there isn't really any way to minimize your pigment prior to the surgery.    Following surgery, lasers are a useful way of fading hyperpigmentation.   Also there are fading creams that can be helpful but are not as effective as laser treatments, in my experience.Check with your surgeon to see if laser treatments are available if you develop hyperpigmentation.

How do you avoid hyperpigmentation after breast lift and augmentation? Is there any way I can minimize the hyperpigmentation?

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