Scar revision for horrible scars: gynecomastia removal with a donut mastopexy 6 months ago. (Photos)

Question

How's it going doctors , i had a gynecomastia removal with a donut mastopexy 6 months ago and was left with horrible scarring. My doctor is performing a scar revision in late January. Is there a possible procedure, a different kind of suture that can aid in having minimal scarring? What alse can i use to help my scars heal nicely this time around. I had very bad tension around my chest the first time i had the surgery. And i feel like that attributed to my scars becoming hypertrophic.

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs and I am sorry that your results did not come out as anticipated.  If your areola reduction was substantial, this was most likely the cause of your hypertrophic scar formation.  In order to mitigate this recurrence I would allow your tissues to completely soften and your tissue elasticity to return before any further treatment.  You may want to consider steroid injections into your scar in the short term.  Hope this helps.

Christopher L. Hess, MD · Answer

No one wants bad scars but they can happen.  Hypertrophic scars (HS) and keloids result from normal healing gone awry.  Factors that result in these include: skin color, traumatic wounds, anatomic location and sutures used during surgery.  HS differ from keloids in that they occur sooner and stay within the original wound.  HS typically begin around four to six weeks after surgery.  If caught this early they are injected with kenalog steroid which typically makes the process stop.  If a revision surgery is necessary then the surgeon should use limited sutures and those with minimal reactivity. Follow up should be every two weeks for several months to watch for returning HS.

Babak Dadvand, MD · Answer

Hi rhouston713,
Thanks for the post and photos. Tension on the scars during the healing process can lead to hypertrophic scars. At 6 months I would not recommend a scar revision, and typically wait at least a year prior to performing a scar revision. Topical treatments that involve silicone can help flatten the scars as can kenalog injections but I recommend following your surgeons advice regarding these two.

Sincerely,
Dr. Dadvand

Scar revision for horrible scars: gynecomastia removal with a donut mastopexy 6 months ago. (Photos)

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