1 year post-op, breasts still seem a little boxy, and scar is a little indented (photo)

Question

I got my reduction on 3/8/24. And it went fine. Had a small infection on one nipple. But other than that went great. Went from 36H to like 36D now. And I feel like they’re still kinda boxy and one has an indent on the bottom where the scar is. Will this settle eventually? Or will I need to go see a surgeon?

Emre Guvercin, MD, FEBOPRAS · Answer

At 1 year post-op, what you’re seeing is very unlikely to change on its own &mdash; and you’re not imagining it.Will this still ‘settle’ after a year?In most cases, no.By 12 months:Swelling has resolvedScar tissue has maturedBreast shape has stabilizedSo persistent boxiness and a visible indentation along the lower scar usually reflect a structural issue, not delayed healing.Why this happensWhat you’re describing is very common after standard reductions:Boxy shapeRemaining breast tissue was reduced but not re-positionedTissue sits wide and low instead of being shaped upwardThe breast becomes smaller but loses 3-D projectionIndented scarScar adhesion (skin stuck to deeper tissue)Minor volume deficiency along the lower poleTension concentrated at the inframammary scarThe small nipple infection you had early on can also increase the chance of localized scarring or tethering &mdash; even if it healed well.Do you need to see a surgeon? Yes &mdash; a consultation is appropriate at this stage.But this does not mean something went “wrong” or that you need a big redo. It means the breast needs reshaping, not more reduction.Best solution: Revision Push-Up LiftYou are a classic candidate for a revision Push-Up Lift.This revision allows the surgeon to:Release scar adhesions causing the indentationRe-shape and re-position your existing breast tissue upward and inwardRestore upper-pole (first-pole) fullnessEliminate the boxy, flat lookSmooth the lower pole contourImprove scar appearance by reducing tensionImportantly:No implant is usually neededCup size typically stays the same (36D)The breast looks rounder, softer, and more naturalWhat will NOT fix thisWaiting longerMassage aloneLaser or scar creams aloneSimple scar excision without reshapingThose approaches don’t address the underlying architecture.

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

Justin Yovino, MD, FACS · Answer

Yes, you should visit with a surgeon and discuss your desires and review your anatomy. Scars will evolve some more with time but it's likely going to remain roughly the same way. Your situation can likely be improved with strategic skin removal including removal of current scars.

Emily C. Wirtz, MD · Answer

Breasts progress through a very normal and relatively predictable change in shape from the immediate post op period through the first year after surgery. At first, breasts are swollen, ride high on the chest wall and may resemble an augmentation. This settles in the first 1-3 months, and the breast resumes a more natural slope with the majority of the breast tissue at the level of the areola and below. Usually these changes stabilize between 3-6 months post-op and any additional changes are slight. This suggests that the results you see today are as close to the final result that you will be after your surgery. If the appearance of your breasts today are not satisfactory to you, you may want to consider sharing your concerns with your surgeon and discussing options. Addressing these concerns will likely require a discussion about surgical options.

Daniel Barrett, MD · Answer

Dear Sociable120807,

I understand your concern. However, without a proper assessment, it would be difficult to determine what is 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

Matthew S. Kilgo, MD · Answer

Hello and thank you for your question.
In general, at one year your results should be fairly stable. At this point, I would recommend a revisional procedure, removing additional breast tissue from the lower outer and lower inner portions of the breast to improve breast shape.  To accomplish this, you would likely require extension of the scars along your inframammary folds. Good luck.

Ellen Ozolins, MD · Answer

Thank you for your question. By one year, most post-surgical swelling has resolved, and the final shape is usually established. A boxy breast shape or indented scar at this stage may not fully settle with time alone. Revision surgery is needed to refine the breast contour and correct indentation from scarring. It’s a good idea to consult with your surgeon&mdash;or get a second opinion&mdash;to evaluate whether revision surgery could help improve the shape and scar.

Joel Patrick Maier, MD · Answer

I can see your concern . . . I think a revision breast lift will help your overall shape and boxiness. Make sure you see an experienced breast plastic surgeon so you can make sure your expectations will be met. Thank you for sharing.

Oliver Chang, MD · Answer

Just based off your photos without examining you or knowing what technique your previous surgeon used, the boxy shape likely won't improve and will likely need a touch up or maybe revision to fix it. And for wide scars, usually don't get more narrow (maybe a lighter in color over time). As of now, if you have visited your previous surgeon and the plan is to do some type of revision for you to help minimize some of these issues to make improvements - that would be ideal (as for waiting for anything to get better after a year is not likely).

Krishna Vyas, MD, PhD, MHS · Answer

Many patients do see some changes in shape over the course of the first year as the tissue heals, but it's also possible that some of these issues may not resolve on their own. If you concerns are boxy appearance and an indentation along the scar, you have a few potential options. Scars typically soften and mature over time. Discuss your concerns with your plastic surgeon who can evaluate the boxy appearance. Sometimes this is the result of the skin pattern design and underlying parenchymal resection and modeling. In some cases, a minor revision may be necessary, which could involve additional skin removal or reshaping the breast tissue. A discussion with your primary surgeon or with a second opinion may provide a more personalized assessment.

Dr. Krishna Vyas, MD, PhD, MHS
Harvard, Johns Hopkins, & Mayo Clinic Educated
Double Fellowship Trained 
Aesthetic Plastic Surgeon
New York, New York

ABOUT DR. VYAS
Dr. Krishna Vyas, MD, PhD, MHS, is a highly trained plastic surgeon specializing in aesthetic surgery and breast surgery, including breast augmentation, reduction, lifts, and gender-affirming surgery (such as chest masculinization and feminization). With advanced training from institutions like Harvard, Mayo Clinic, and Johns Hopkins, Dr. Vyas is recognized for his expertise in breast and chest sensory nerve restoration. His PhD in clinical and translational science focused on stem cells, fat grafting, and improving outcomes in aesthetic surgery and breast surgery. Dr. Vyas has served on the editorial board for several medical journals and platforms and has over 200 research papers and talks. His research focuses on aesthetic surgery, regenerative medicine, stem cell biology, fat grafting, breast surgery, and gender-affirming surgery. Recognized for his expertise, Dr. Vyas was appointed an Instructor of Surgery at Mayo Clinic and served as an Assistant in Surgery at Harvard Medical School and Massachusetts General Hospital.

1 year post-op, breasts still seem a little boxy, and scar is a little indented (photo)

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