What can I do to improve my keloid scarring? (Photo)

Question

I was diagnosed with breast cancer January of 2023 with a single mastectomy in August last year. I was so careful with my incision because I feared the scarring. Well it has develped into a keloid and I dont know what to do. I'm scheduled at the breast center to see plastics but I just learned that keloids can come back. My skin is already so tight and painful. I was hoping for delayed reconstruction but at this point, I'd just like my skin normaI. Please advise me. :,-(

Raffy Karamanoukian, MD, FACS · Answer

Keloid scars are characterized by their growth potential and increased degree of inflammation within the skin. Unlike non-inflamed scars, keloids have the potential for growth beyond the original footprint of injury. Our office specializes in the management of keloids, whether single or multiple, using a combination platform that includes lasers, RF, scar modulation, Parke-Davis Scar Protocols, and injection therapy. Some keloids will require surgical intervention as an initial step for treatment. 
Best, 
Dr. Raffy Karamanoukian
Realself 100 Surgeon

Jeff Rapaport, MD · Answer

Treatment for your post Mastectomy keloids can involve various methods:
Bleomycin: This medication can be injected directly into the keloid to reduce its size and redness by inhibiting collagen production.
5-fluorouracil (5-FU): Another option is injecting 5-FU into the keloid, which interferes with the growth of abnormal cells and can help reduce redness.
Corticosteroids: Injections of corticosteroids can also be used to reduce inflammation and redness in keloids by suppressing the immune response.
Pulsed Dye Laser (PDL): This laser treatment targets blood vessels within the keloid, reducing redness by minimizing blood flow to the area.
Intense Pulsed Light (IPL): IPL therapy can also target blood vessels and reduce redness by selectively heating and damaging them.
Cryotherapy: This involves freezing the keloid with liquid nitrogen, which can reduce redness and flatten the scar tissue.
Topical Silicone: Silicone gel or sheets applied directly to the keloid can help flatten and soften the scar tissue, reducing redness over time.
Each treatment option may vary in effectiveness depending on your response  and the characteristics of the keloid. Combination therapies may also be used. Multiple sessions will be necessary.It's essential to consult with a dermatologist/scar expert  to determine your most suitable treatment plan.
Jeff Rapaport MD 
Realself Hall of Fame 
Castle Connolly Top Doctor

Nelson Lee Novick, MD · Answer

Simple solution: the intralesional injections of steroids, such as triamcinolone, is considered the treatment of choice for shrinking and flattening keloids and for alleviating the often accompanying symptoms of itching, pressure and tenderness. You would be wise to consult with a board certified cosmetic dermatologist scar specialist. Best of luck.

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