What advice would you offer to patients with a history of keloids and scarring when preparing for a breast lift with implants?

Question

I am considering a breast lift with implants. However, from past experiences I tend to heal with scarring. I have also had keloids from piercing my ear cartilage. I scar up from itching mosquito bites, from scrapes, etc. I am African American, and I know this is common, but my question is what would you recommendations/advice would you give to your patients? Thank you.

Ryan A. Stanton, MD · Answer

Indeed because you have a history of keloid scarring, you are at higher risk for having thickened, darkened and/or true keloid scarring from a breast lift. That being said, the risk is definitely not 100%. Unfortunately how scars heal is only about 30% up to meticulous wound closure by a skillef plastic surgeon but the other 70% is up to the patient’s genetics.  If your desire to have a breast lift is strong enough and outweighs the potential risk of keloids then I would probably recommend going forward with it. If indeed you do form keloid scars they can later be revised with a combination of excision and immediate postop radiation treatments with quite good success. Glad to be of help.

Raffy Karamanoukian, MD, FACS · Answer

Keloids can occur anywhere on the body as a result of skin inflammation or injury. In my practice, I usually opt for nonsurgical treatments first followed by surgery if necessary. Our patients benefit from multi-modality protocols that include scar modulation, application of Plato's Scar Serum twice daily, Replenish retinoid cream, laser therapy, and Kenalog IIT. 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Gary M. Horndeski, MD · Answer

The
technique I recommend is The Bellesoma Method. 
The advantage of this method is that the closure around the areola has
minimal tension and less likely to scar. 
Also, the vertical scar is eliminated. 
The only scars will be at or near the inframammary fold.  This technique was developed specifically for
people who have a history of bad scarring. 
Unfortunately, you have not provided photographs or told us your bra
size.  The other alternative, instead of
implants, is fat transfer.  Implants are
not lifetime devices and half are removed by 9.5 years.Best Wishes,Gary Horndeski, M.D.

Urmen Desai, MD, MPH, FACS · Answer

I recommend use of silicone based scar cream (Biocornium) after surgery.  I also recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

Luis M. Rios Jr., MD · Answer

Be very careful when pursuing a breast lift. Scarring is part of the process.If there is any way to get a lift without breast lift scars, this would be my first option. Sometimes internal procedures can be done to simulate the lift.There are some newer skin tightening technologies that might also help you get a lift without significant scars.The only way to know for sure is to get a consult with an experienced plastic surgeon. Several opinions would be good in your case.Good luck.

Daniel Barrett, MD · Answer

Dear Big Bad Wolf,scar prevention begins in the OR during the surgery when I meticulously close wounds in multiple layers in order to reduce tension and reduce scars width. I tape my incisions during the early postoperative period to reduce micromotions of the tissues so the incision can heal earlier. I also use compression garments and later Biocorneum gel.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ewa Majdak-Paredes MD, PhD, FRCS(Plast) · Answer

Thank you for your question.
If you are fully committed to having breast uplift with implants with a history of keloid scarring then there are a few things that can be done to minimise the risk or area of scarring. Firstly, your plastic surgeon might try to avoid what is called a Wise pattern scar which is essentially an anchor scar with a long scar in the breast fold (inframammary fold). Perhaps it might more appropriate in your case to consider much shorter scar what is called a vertical scar (lollipop scar without a long scar in the breast fold) or a lollipop with a very short horizontal scar in the fold. There are certain areas in the body which are more prone to heal with keloid scarring such as middle of the chest in the front, ears, shoulders or jawline. By trying to avoid a long scar in the breast fold which often extends to the middle of the chest (an area prone to keloids) at least you are minimising your risk of developing a keloid scar in that area. I am not sure whether or not you had steroid injections to your keloid scars in your ears and responded well to those. If you did then at least this is a good sign in the sense that if you start developing keloids after your uplift then they can be treated with steroid injections hoping for good response. Sometimes your plastic surgeon might discuss with you giving you steroid injections at the time of your surgery (there are pros and cons). In addition, I would also recommend using silicone gel or silicone patches after surgery as well. But, bear in mind that keloids scars are difficult to manage and they can also be symptomatic i.e. painful and itchy. 
Hope this helps.

Robert L. Kraft, MD, FACS · Answer

If you are a keloid former, I have easy advice for you: don’t have elective, cosmetic surgery. Keloids can be treated but, in the breasts, they can be disfiguring.  The suggestion of nonscar lift is hypothetical and no guarantee of a good outcome.

Lori L. Cherup, MD · Answer

It's very simple.  Have the surgeon do a test incision on your areola and your inframammary fold. If they heal well, then do the surgery.  If they don't, DO NOT do it.

Lori L. Cherup MD, FACS, Pittsburgh, PA

Jon Ver Halen, MD, FACS (license suspended) · Answer

Dear Big Bad Wolf,Hello and thank you for your excellent question. I recommend that you have a frank discussion about your concerns with your surgeon. He or she should use every available technique to minimize your scarring. Postoperatively, be sure to use silicone sheeting, Embrace, or another proven technique to minimize postop scarring.  Finally, have a low threshold for postop intervention with steroid injection (once you are completely healed).  Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. If you have any questions, call our office for assistance. Good luck!
  
Best,
  
Jon Ver Halen, MD FACS
  
Harvard educated plastic surgeon
  
Texas “Top Doc” 2017, 2018
  
RealSelf100
  
America’s Top Plastic Surgeons, Consumer’s Research Council, 2010 – 2018
  
BeautyAdvisor Top Contributor

What advice would you offer to patients with a history of keloids and scarring when preparing for a breast lift with implants?

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