How can I get rid of my scar/keloid on my areola incision from breast augmentation? (Photo)

Question

Did this happen because of how my Dr stitched it? Should I consider a Scar revision? Also, as you can see it seemed to be a chemical burn from the scar strip that my dr gave me.. now it's a brown spot that left on top of my areola, i have considered bleaching my skin just that part. Please help!!

S. Larry Schlesinger, MD, FACS · Answer

It appears that you have a depigmented (white) scar at the bottom of your areola, and a smaller scar at the top of your nipple.  If you were my patient, I would tattoo areolar pigment over both of these depigmented areas.  I use a circular template, referred to as a cookie cutter, which is round.  By using this to define the outer edge of the areola and tattooing within the borders, minor skin discolorations as you have at the top of your areola from a chemical burn become less obvious.

Raffy Karamanoukian, MD, FACS · Answer

Keloid management must follow a protocol approach. Our office uses a 
combination of Vbeam laser, Kenalog IIT, scar modulation, scar serum 
therapy, and enucleation. 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Joel Patrick Maier, MD · Answer

Sorry to hear about your concerns . . .
It looks like a hypertrophic scar and unlikely due to how your surgeon closed
the incision. There is evidence that fractionated CO2 laser works to soften and
flatten scars such as this and would be and easy option. Something to consider.

Shim Ching, MD · Answer

Dear Msasian808Thank you for your question.Your scar is quite visible.  I usually try to avoid the periareolar incision for this reason.  To fix the scar, I would cut out the scar and resuture it.  I would consider converting the scar from a curved line to a jagged line to minimize the appearance and reduce the risk that it would become a raised scar again.  Steroid injection can also help prevent this.  Above the areola, there is an area of hyperpigmentation.  This could be due to the scar strip you used.  The darkened skin would likely improve with a bleaching cream such as hydroquinone and IPL treatments.  IPL is a light based treatment, similar to laser, that can target pigmentation in the skin and lighten it considerably.We would be happy to see you for a consultation.Aloha,Shim Ching, MD

Lewis Albert Andres, MD · Answer

It is common for scars to fully mature for up to a year. In the meantime, there are a few things that may help to ameliorate your incision/scar. The most proven (as well as cheapest) modality is simple scar massage. Applying pressure and massaging the well-healed scar has been shown to improve the appearance as it breaks up the scar tissue, hopefully producing the finest scar as possible. Other things that have been shown to add some benefit, albeit controversial, are silicone sheets, hydration, and topical steroids. In addition, avoidance of direct sunlight to the incision will significantly help the appearance as they tend to discolor with UV light during the healing process. If unsightly scars are still present after approximately a year's time, other things that your surgeon may consider are intralesional steroid injections, laser, or just surgical revision of the scar itself.  It appears as if you had a breast lift at the same time?  Depending on the time from the procedure, some of these modalities or laser therapy may help.  However, scar revision may certainly be entertained, which could be performed at the same time as any revisionary procedure, if you are unhappy with the result.  A revision to excuse the scar and re-inset the nipple-areolar complex would likely be the best option for the appearance of yours. Hope that this helps!   Best wishes!

Stephen M. Davis, MD, FACS · Answer

The question is what makes scars better:1) Time2) Pressure3) Massage4) Silicone sheeting5) Vitamin E (Topical), controversial6) SteroidsBased on your photo it appears as the scar is still immature ( firm, raised, ropey). I would suggest simple stuff first. Massage is simple, but the issue is scar works 24 hours per day and we massage 3-4 times a day for 5-10 minutes. I would suggest surgical silicone sheeting, here is the issue. This is a commitment, you have to wear it 23 plus hours per day for 2-3-4 months. You can wear it in your bra, it is soft, supple and clear. All you need to do is cut a crescentic piece and wear it. You can use the piece over and over till it starts to crumble then cut a new piece. You can wash it with soap and water and let it dry while you are in the shower then re-apply it.All of the above list stimulate an enzyme called collagenase, which accelerates the conversion of early scar ( type III collagen) to mature ( type I) collagen. Be patient, time is your friend. When the scar flattens and if colour issues are a problem then tattooing works well.Good LuckStephen M. Davis, MD FACSGreen Hills Plastic Surgery

Thomas M. DeWire Sr., MD (retired) · Answer

msasian808,You show thick scarring (hypertrophic scarring), and not keloid, as that is a specific type of pathologic scarring that grows outside of the area of injury, an invades surrounding skin. Both hypertrophic scarring and keloids are genetically determined, but hypertrophic scarring is more related to location on the body, scar orientation, and scar tension. Of those factors, only the tension can potentially be changed, as the scarring will have to be at the same place and oriented the same way if you undergo revision. The flattening of the hypertrophic scar at the upper pole of your areola has caused the broader discolored scar, and that is what scar strips do. They will not shrink or narrow scars, but only will speed flattening. Eventually the scar may assume a more normal color match to your surrounding skin, particularly if you are Asian or Polynesian, where scar darkening is common, followed by eventual fading of the color. This is not a result of how the wound was sutured, and different suture technique is not likely to yield a different healing tendency. However, this does appear to be the result of a Benelli-type breast lift, and thus if the scar revision is done as a stand alone procedure, without the added tension of the implant placement, then you may heal more favorably, but no guarantees can ever be offered in that regard. Further information about keloids versus hypertrophic scars is found at the link that follows.  I hope that this helps.

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