Best way to prevent bad scarring after anchor breast lift and implants?

Question

I will be having an anchor style breast lift and implants placed in January. What are the best ways to remedy the scars? Do you have any opinions or suggestions on what to do prior to surgery as well as after?

Vaishali B. Doolabh, MD, FACS · Answer

Hi srarmstrong86.  In general, the scars that are underneath the breasts tend to be more noticeable than the vertical scars or the scars around the areola, regardless of the surgeon, because anatomically the infra-mammary fold is a zone of adherence in the body.  The vertical breast lift method doesn't use the full anchor, specifically the scar underneath the breast is not created.  Depending upon the degree of sagging, you may be a candidate for this-talk to your PS.  Your surgeon will consider that using less reactive sutures can help, and having less tension on the closure (for example, by using barbed sutures) can help.  If you have a tendency towards hypertrophic or keloids, then steroid injections will be helpful.  Not smoking will ensure that you have a robust blood supply to help healing in general.  Topical medical grade silicone application (gels, pads, liquid) are all useful.  Months later you may consider laser treatments to diminish the color and/or microneedling to help with crepe-ness.  It is important to give the scars about a year to fully mature-become flat, soft, skin colored, non-tender, thin, etc.  Best wishes,

Jed H. Horowitz, MD, FACS · Answer

A #mastopexy or breast lift operation is designed to improve the shape and position of the breasts without reducing their size. It is used for #breasts which sag or droop (ptosis). Sagging of the breasts may occur with normal development for some women, or as part of the aging process. Pregnancy, breast-feeding and weight loss are other conditions which increase breast ptosis. Some patients will have a better shape to their breast such as increased superior fullness if an #implant is used at the time of mastopexy. This is called an #Augmentation/Mastopexy. The procedure can also be combined with a minor breast reduction to reduce the breast width if desired. The surgery will create an elevated, more youthful breast contour. Also, the procedure will create nipple and areolae of the desired size and at the correct height.  #FatGrafting is another option to using #breastimplants and requires a small amount of liposuction to obtain the fat which is the prepared and transferred to the breast.  A hybrid operation may use both an implant and fat to provide the best contours of the lifted breast.I prefer to use a #shortscar technique, #LollipopScar or #DonutLift” rather than the majority of surgeons in the United States that use an anchor pattern lift which involve more significant scarring.

Ira H. Rex III, MD · Answer

Surprisingly, there aren't that many interventions to improve scars. It has been shown that taping incisions for about six weeks can minimize scarring. A silicone-based product applied to the scar has also been shown to work. I prefer a product called Biocorneum which has the best scientific studies to show its effectiveness. This is used for about three months. Check with your plastic surgeon about their preference.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Every surgeon has their own scar management protocol.  I always have my patients on biocornyium post-op.  A breast lift with implants can be designed to result in an
improved shape and contour of your breasts while minimizing scar
appearance.  Make sure you specifically look at before and after
pictures of real patients who have had this surgery performed by your surgeon
and evaluate their results.  
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Scott Chapin, MD, FACS · Answer

The best way to prevent bad scarring in this procedure is to find an experienced Board Certified Plastic Surgeon who knows how to design and perform this procedure so that there will be minimal tension on your scars.  All the scar cream in the world will not prevent bad scarring from a poorly designed [ie too tight] lift.  I would recommend you study each particular Plastic Surgeon’s lift photos carefully.  Ask for multiple photos of patients with lifts at the consultation as well.

Nicholas Tarola, MD · Answer

Thank you for your question.  Scar appearance depends on how each individual heals, the tension across an incision closure, postop complications such as infection or delayed healing, smoking, exposure to UV light, etc.  The size of the implant plays a large role on final scar appearance specifically in an augmentation/mastopexy procedure.  In order to decrease your risk of poor healing, it is often recommended to be conservative with implant volume (less than 400 cc).  It has been suggested that you seek a second opinion because your surgeon has recommended a Wise pattern (anchor type) mastopexy over a vertical mastopexy.  I disagree.  While a vertical mastopexy is an excellent technique, it is inferior to the anchor type in cases of more severe ptosis/droopiness.  Following your procedure, your surgeon will make recommendations for optimal scar formation.  Most surgeons will recommend waiting at least two weeks after surgery before applying anything.  I typically recommend a silicone based topical scar treatment.  Hope this helps.  Best wishes!

Jonathan Weiler, MD · Answer

IMO a anchor scar should not be used for a lift with implants these days, a Vertical Mastopexy is the best method by far , will give you superior results and less scarring, IMO would seek a second opinion, also would suggest a PS who will layout a post surgical plan to minimize scarring, good luck!

Robert T. Buchanan, MD (retired) · Answer

The majority of what can be done to optimize scar appearance is already decided, as you have chosen your surgeon and that is the most important part because the technique of the procedure and closure are the major determinant of the final scar appearance. You can, however, still do some things. The first is to stop smoking if you do. Second, you need to make sure your diet is as good as possible. Post operatively, you will need an increase in protein to support healing.

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