Options For Hyperpigmentation of Breast Reduction Scars on Light Skin? (photo)

I had a breast reduction done 6 months ago at 19. I do wish more tissue had been taken, but that's not my main issue. I've had darkened pigmentation around the scars since shortly after surgery, and it has not improved at all in the 6 months after despite using silicone sheeting and BioOil. I have been trying to find other examples of women with a similar problem, but it seems much more common in darker skin. I am Caucasian with fairly light skin. What are my options to deal with this?

Doctor Answers 9

Hyperpigmentation in Breast Reduction Scars

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Pigmentation of the vertical scar following breast reduction can occur for two reasons. It either represents residual peripheral areolar pigment that was not excised, or occurred as result of the inflammation associated with surgery and the healing process (post-inflammatory hyperpigmentation, PIH).

In women who have large areolas, it may not be possible to remove all of the areolar pigment with the design of the breast reduction, and so some of the peripheral areolar pigment may remain in the region of the vertical scar. This is more likely to occur in women with a large areolar diameter who require less skin reduction. In order to prevent the vertical skin closure form being under too much tension, a small amount of this pigmented skin is left to promote better healing with less risk for wound dehiscence or scar widening. When healing is complete following breast reduction, it may be possible to excise this residual pigmented skin.

The inflammatory process can stimulate pigment production. Therefore, trauma, surgical incisions, infection, and the normal healing process call result in PIH. PIH is more common in individuals who have darker skin types, because more pigment is obviously present in the skin; but it may also occur in lighter-skin individuals. The extra pigment associated with PIH may be very difficult to address when present in scars. Chemicals such as hydroquinone, kojic acid, retinol, and others have been shown to reduce or suppress pigment formation and may be helpful for PIH. In darker-skinned individuals, where an increased risk for PIH is anticipated, these products are best used for 8 weeks prior to the procedure that will cause an inflammatory response; they are then continued for several months afterward while healing occurs. It is also worth noting that residual areolar pigment remaining in the vertical scar may darken as a result of PIH.

One other thought: There are situations where residual redness in a scar may give the visual appearance of a brown color. This is most often seen in scars that are still healing and have not yet matured; scars may at times have, blue, red, purple, gray, or brown hues. If you run your finger along these types of scars, the skin will blanch and the scar often looks better. This redness will often fade with time, and this maturation process may take one year or longer. Resolution of this redness can be hastened with intense pulsed light (IPL) and/or Laser Genesis procedures. Some scars remain pink because fine dilated capillaries are present within the scar and/or the immediately surrounding skin. These scars will blanch with finger pressure as well, and light-based therapies may offer improvement.

You should seek the advice of your surgeon to discuss these various options. If your scars do demonstrate hyperpigmentation, and you have no plans for future surgery, I would recommend a bleaching agent; these are more effective when started sooner. If the coloration stems more from redness, this will likely improve with time. If at some point you choose to have additional breast tissue removed, this pigmentation would be excised at that time as part of your operation. UV radiation is a huge stimulus for pigment production, so sun avoidance behaviors and the use of a broad spectrum sunscreen are critical to individuals concerned with, or treating, hyperpigmentation.

Best wishes. Ken Dembny

Milwaukee Plastic Surgeon
4.9 out of 5 stars 36 reviews

Treatment of dark and hyperpigmented scars on the breasts with Melaquin PM cream twice daily

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I would recommend the Melaquin PM cream for treatment of the hyperpigmentation and discoloration.  Treatment of hyperpigmentation takes time, however. Surgery90210

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Dark Scars after Breast Reduction

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hi there-

Breast reduction scars can be more conspicuous than we would like for several reasons. While it is possible that the color is related to your surgeon's inability to completely excise pigmented areolar skin at the time of your surgery, it looks to me in your photo more like your scars are simply immature.

In fair skin types, the pinkish-brown color that occurs as a result of the inflammation that is a normal part of the healing process can persist for some time. Rest assured that as scar maturation proceeds (this process can take up to 18 months), this color will continue to fade and should eventually approach the color of your surrounding skin.

My advice were you my patient, therefore, would be to no do any more than you are currently doing, until at least 18 months had passed since your surgery. At that point other options could be entertained if necessary. And definitely don't do anything without talking to your surgeon...

I think it is very important to say that for all postoperative concerns and questions, I think the very best thing for all patients to do is to discuss it with their surgeon and give his opinion and recommendations much more weight than they give mine (or anyone else's on the web).

The reasons I say this are that only your surgeon understands the details of your exam, your skin type, your surgery, and what has been successful in his practice in the past. Furthermore, your surgeon is the one you will hold (at least partially) responsible for your outcome.

It's therefore only fair for you to give him the best opportunity to make you happy without interference from doctors who don't know you.

Scar Hyperpigmentation

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

As others have stated it will take a year for scars to settle. Something that you may want to try is topical 4% hydroquinone. This is a prescription but also comes mixed with Glycolics to potentiate the effect. It is considered a "skin bleaching cream" but actually just slows the deposition of pigment from the melanocytes (pigment cells in your skin). You will need to use it for 4 months to see if it will help and avoid UV exposure (tanning booth). If this does not help and a year has passed, the scars could be revised but I would forewarn you that the same thing may happen since this is more related to how you heal as opposed to the surgery. If your scar  "blanches" on compression, this is indicative that it is more related to the normal process of inflammation that usually resolves by a year. If this type of situation persists,  then IPL (Intense Pulsed Light) therapy or the use of a pulsed dye laser could help.

Scott R. Brundage, MD
Grand Rapids Plastic Surgeon
4.8 out of 5 stars 27 reviews

6 months after breast reduction and scars

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Scars take about a year and sometimes longer for the redness to go away.  Give it more time to settle down.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Dark Scars after Breast Reduction

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hello Daisy,

As the others have suggested, I believe your hyperpigmented scars are actually residual areolar skin. 

I would wait a full year, and reassess. If you feel that the appearance is unacceptable, you may consider a scar revision, possibly with further reduction as well if you feel you are still too big.  This will allow the surgeon to fully excise areolar skin and will probably leave you with light colored scars.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Bad scars after breast reduction

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Breast reduction healing is often dependent on skin type, and tension in the closure. The vertical scar you are having trouble with will pale out over time and look much better. Occasionally there can be a bit of the the areolar skin left in the vertical limb, and a revision can help clear it up.

Best of luck, peterejohnsonmd.com

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Breast reduction result

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
FIrst, I think you did not have a sufficient reduction, as you suggest. The breasts are still very large and will go on to sag, a well as to produce the same pain pattern in your neck and shoulder as before. You are doing the right thing by using silicone sheeting. Scarring can take up to a year to resolve. Your scars appear spread apart and this may require scar revision to improve their aesthetic appearance.

Hyperpigmented Scars in Breast Reductions

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

There can be different causes for scars to have skin darkening around them.  Sometimes in a breast reduction, there is a little portion of the darker areolar skin that ends up on the vertical scar as the breast "envelope" is being brought together.  That  cause of darkening is most common in women with wide areolas.  If that is the cause of your scar's hyperpigmentation it will not go away.  It may be possible at a later date to excise the darkened skin and reclose the vertical scar.  Some skin types release melanin (brown skin pigment) in response to healing or inflamation.  This is more common in darker skin types.  Fade creams, such as hydroquinone can help block that release .

Mary Lee Peters, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 117 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.