Hypertrophic Scarring Under the Breast Crease

I removed my implants 8 mnths ago.At 4 wks post-op I developed slight hypertrophic scarring - slightly thickened & seemed attached to the underlying tissues.My PS recommended I massage the scars for 6 mnths.I did this & noticed that the skin 'released' so I stopped abt 1 mnth ago.I have now noticed that my left crease is 'attached' again to the underlying tissues.I have started my manual massage again.My PS and I are no longer on good terms so any suggestions on rec rx would be much appreciated.

Doctor Answers 1

Hypertrophic Scarring in Breast Crease

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It sounds like you have two separate but potentially related problems. 

First, the hypertrophic scarring. By this I assume you mean that the scar is thicker and more firm and red that it ideally should be. This is actually somewhat unusual as the breast crease, or inframammary fold, is generally a very favorable area for scars. Early on, scars can potentially benefit from some topical scar formulas such as Mederma. At this point those treatments aren't very effective. The scar could be injected with a steriod, but that often turns a hypertrophic scar into an atrophic scar (also unsightly). Appllication of a sllicone sheet or bandaid can be helpful at this stage but it must de done diligently (i.e. worn 24/7 for several months). Also if your scar is truly hypertrophic then this could result in tethering.

Second, tethering. This could be caused by a thicker or hypertrophic scar as I noted. I think a more likely cause is that the subcutaneous tissue layer was not carefully closed at the time of explantation. This results in the scar being tithered down to the underlying muscle fascia without the separation of the subcutaneous fat layer. A little bit of tethering is to be expected initially as the wound heals and matures, and massage can help this. But if your scar has retethered, or it appears to be depressed relative to the surrounding tissue, then massage will not likely result in satisfactory. It is possible that a revision of the scar will be required to achieve a good long term result.

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