Incisions for Tissue Expander Surgery? (photo)

I just had tissue expander surgery with an older Dr. He extended my mastectomy scars with the incision saying it was to prevent pectoral muscle damage. Is this technique unusual? Other surgeons told me they would not extend the incision line. Now I have very wide scars. Second question: anything I can do to make my original scars thin and white? It's been 2.5 years. Why do some people's scars fade quickly? Thank you.

Doctor Answers 8

Tissue Expander/Breast Reconstruction Incisions, Scar Improvement

Depending on how large your original incisions were, sometimes extending the incision is necessary in order to be able to adequately visualize and access the parts of your chest for reconstruction or to free up some scar tissue, however every surgeon has his/her own preferences and zone of comfort regarding the size of incisions. What you have in your posted photo is not completely out of the range of what one might expect, and the scars can be revised at the time you have your expander exchanged for an implant. 

Scars are usually pink or darker and fade over time depending on your skin type and level of pigmentation. Within the first few weeks of surgery, I usually have patients start silicone gel treatment or silicone sheeting if they have a history of hyperpigmentation or poor scarring. Keep in mind that treatments must be continued for up to a year for maximal results.  If the scars are 2.5 years old and you are unhappy with them, it may be worth a discussion to revise/excise and re-close them, and treat aggressively as described above afterwards. 

Minneapolis Plastic Surgeon
5.0 out of 5 stars 10 reviews

Scarring after Tissue Expander Insertion

It appears that your surgeon made a longer incision to allow access to the undersurface of your pectoralis major muscle.     This will help keep the muscle intact and allow it to provide coverage around your implant.   Muscular coverage helps reduce the risks associated with implants such as capsular contracture and infection.

In regards to your scar widening, it is probably due to expansion process.  As the skin stretches, so do the scars.    This scar can be easily revised during the  expander to implant exchange process.

I wish you a safe and healthy recovery.

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 87 reviews

Incision for Expanders and Wide Scars

    A lot of breast reconstructions with tissue expanders are performed immediately after mastectomy using the same incision.  In a delayed fashion, the same incision can be used.  Wait until your reconstruction is complete before evaluating final scars.  Revising anything at this point would just suffer due to the expansion process.  Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews

Tissue expander incision...why go lateral?

Your doctor made this incision so he would not have to cut the pectoralis major muscle.  He dissected under the pectoralis muscle from its lateral border.  Not everyone does this but in his experience it is preferable.  The scars for any breast surgery are difficult to treat.  Silicone tape products seem to work the best for my patients.

Mark A. Schusterman, MD
Houston Plastic Surgeon
4.9 out of 5 stars 77 reviews

Enlarged mastectomy scar

I will usually use the original scar or a new one at the base of the breast for the second stage.  The scar will improve most likely with time.  The scar can be revised at the second stage or if you undergo nipple reconstruction

Charles R. Nathan, MD, FACS
Saint Louis Plastic Surgeon
5.0 out of 5 stars 72 reviews

Breast reconstruction

The incision used to place a tissue expander or a permanet implant is the same one as the mastectomy incision in most cases.  Hard to say why it was extended.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Breast Reconstruction

Scras to insert a tissue expander are ususly the same as that of the mastectomy. With expansion the scar can get wider. it takes about one year for scars to settle and fade.

if the scar is too wide then at 6 months a scar revision can be done and use of silicone gel sheeting will fade the scar quicker.

Samir Shureih, MD
Baltimore Plastic Surgeon
4.2 out of 5 stars 7 reviews

Incisions for Tissue Expander Surgery? (photo)

Hello!  Thank you for your question!  A horizontal or vertical incision across your chest after mastectomy, given it is a skin-sparing mastectomy with removal of your nipple-areola complex, are typical.  When performing the breast reconstruction, it is common to use the same incision.

It sounds as if you had a delayed reconstruction done at a later date from your initial mastectomy?  If so, your surgeon used your same incision and it is not uncommon to extend the incision so as to give you, what s/he believes will give him/her best visualization and access in order to perform the reconstruction.  Especially if it is a limited incision from which the original mastectomy was performed, the incision may in fact need to be lengthened.  It is a matter of personal preference, but most importantly, what your surgeon will need to offer you the best result in his/her hands.

It typically takes up to a year for your final result and scarring to fully mature.  I would not worry about your incision at this point, given there are no issues with it now, since your second stage for replacement of expanders for implants will likely excise this scar and suture again.  At that time, scar revision of your previous incision may be considered to create a finer scar as well.  Hope that this helps!  Best wishes for a wonderful result! 

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 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.