Horrific scars after explant and now pancake breasts! Can scars be reduced? When can I consider a fat transfer? (Photo)

Question

Female aged 51, white, height 5’5”, weight 52kg Horrific scars and now pancake breasts! Can scars be reduced and how long to wait before considering fat transfer procedure?

Raffy Karamanoukian, MD, FACS · Answer

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars. 
 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Daniel Barrett, MD · Answer

Dear LisaPM,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ronald J. Edelson, MD · Answer

It appears your explant  was recent. You don’t give a reason for the explantation. You should wait at least six months before doing anything and reassess your options at that time. Ideally you need a lift and volume added. Don’t know if placing an implant again is an option. You are looking at a multistage reconstruction whether it is with fat or a saline implant. It’s a very tough case

Connie Hiers, MD, FACS · Answer

With your bruising and scars, you are very early in the healing process. Once you have reached 6 months from removal, you could consider a lift or fat and lift. Your scarring is not horrific, and micro-needling can be helpful.

Douglas Taranow, DO, FACOS · Answer

Lisa,
You right breast scar is anything but horrific!  It appears to be very early in the postoperative healing phase and expect the scar to slowly fade (it was placed properly in the inframammary breast crease).  The breast deflation and wrinkling is a normal sequalae of explantation.
A fat transfer should not be attempted for at least 6 months to allow the swelling to subside and the capsules to collapse.  Fat transfers to the breast routinely enlarge the breasts ONLY 1/2 cup size. 
Best wishes,
Dr. Taranow

Mats Hagstrom, MD (license on probation) · Answer

Your questions and concerns need to be put into context. It takes 12 to 18 months before skin incisions mature. You cannot judge scars early after surgery. You’re still bruised so your surgery was done fairly recently.
There is a lot more information we need to get an understanding of what’s going on with you. Why did you remove the implants?
Did you have caps or contractures?
Did you have capsulectomies?
If so that would explain needing a much larger incision than for a typical explantation.
Where are drains placed?
Your breast look uneven. Were they like that before your augmentation?
Do you have a fluid buildup in the bigger breast?
Fat transfer is an option but it is not going to even come close to what the implant was capable of.
The first round of fat transfer could’ve been done during explantation.
If not then you need to wait at least six months before considering any second breast procedure.
For the scars do you need to wait until they’re mature. This is not how they are going to look long-term.
Have you followed up with your surgeon and ask them these questions?
This all sounds like routine surgery follow up type of questions you should discuss with your provider.
The number of providers who can consistently deliver quality liposuction and fat transfer results is relatively small. If you want that procedure you need to be highly selective and interview and number of plastic surgeons. My recommendation is patients have only in person consultations. During each consultation ask each provider to show their entire collection of before and after pictures. Being shown a handful of sample pictures which most likely represent the best result of the providers career is totally insufficient to get a clear understanding of what average results look like. And experience provider should have no difficulty showing you at least 50 sets of before and after pictures. Ask the surgeon to show as many pictures as possible of patients with similar body characteristics to your own. You need to be assessed independently for liposuction and independently for fat transfer since having a fat transfer procedure includes doing two operations at the same time.
When reviewing pictures ask to see as many pictures of patients Who have similar body characteristics and breast characteristics to your own. Ask to see examples of excellent outcomes, average outcomes and less than outcomes. As of the provider how many patients ended up having a revisions and ask to see what the results look like of patients who needed revisions or results that didn’t turn out well.
Do you need to come well prepared for consultations considering your history. You should bring with you all sets of before and after pictures of both the augmentation and explantation. If you don’t have those before and after pictures then you should ask the surgeons who did the procedures to forward the ones they took. You should also ask for copies of your operative report so that the new plastic surgeon can learn if you had capsules and if they were removed completely.
Look critically at all Liposuction results making sure there are no skin contour irregularities in any of the areas treated with Liposuction. As the surgeon to go over the results with you looking carefully at treated and non-treated areas looking to make sure the transition zone between treated and on treated areas look completely natural.
Bring with you pictures of your own breasts in your own torso so you have reference pictures for comparison to find other patients who have similar characteristics to your own. You won’t be able to remember what your body or breast look like without having pictures at hand for you to use for a comparison.
Continue having consultations until you feel like you found the right provider for you.
For fat transfer make absolutely sure no one is showing you early postoperative results. All postoperative pictures of fat transfer need to be a minimum of 3 to 6 months out from surgery. Just like you were showing us early results of your scar. That picture does not at all represent with your final score is going to look like. The same is true for fat transfer. Early fat transfer results can look very very impressive but this is not at all represent what the final results look like.
Anyone showing it after pictures with the patient still in the operating room or the recovery area or still with bruising or surgical markings on their body should be dismissed as not showing accurate pictures and simply go on to the next consultation.
Find the right plastic surgeon and everything falls into place. 
It would be helpful to understand why you had an explantation since the easiest way to restore the volume of your breast including the shape of your breasts which cannot be restored with fat to simply re-augment with implants.Fat transfer can increase the size of your breast by about 1/2 cup but it does not change the shape of your breast whatsoever.
What most women really want is a good looking breast and that often includes changing the shape of it. Fat is not good for this and implants are superb for it.
continue having consultation until you find the right plastic surgeon for your needs. 
good luck,
Mats Hagstrom MD

Horrific scars after explant and now pancake breasts! Can scars be reduced? When can I consider a fat transfer? (Photo)

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