What can I do about keloid scarring after breast augmentation in 2019? (Photos)

Question

I had a breast augmentation in 2019 and started developing keloid scarring shortly after. The incision was made in the fold of the breast and the scarring that's developed is painful and itchy. I started using kelo-cote gel shortly after the scar started developing, but it hasn't worked at all. Over two years post surgery, I'm still not quite happy with my breasts.

Brian K. Reedy, MD · Answer

Thanks for your question!
Speak with your surgeon for guidance on treatment for your scars. There are lasers, micro needling and
injections that may help. Best wishes!

Raffy Karamanoukian, MD, FACS · Answer

Cosmetic surgery procedures require a disciplined approach to scars, whether or not the incisions are placed on the face or body. In our Los Angeles plastic surgery clinic, we recommend that patients follow basic wound healing guidelines followed by the application of Plato’s Scar Serum twice daily once the skin is healed. If the incisions are prone to pigmentation, addition of Melarase PM is required. After a few weeks, the skin heals over and laser therapy is initiated to further improve scarring.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Amir Sadr, MD, MSc (Plast), FEBOPRAS · Answer

Dear Cola109
Thanks for sharing your photos and asking your question about treatment of keloid scar after bilateral breast augmentation. This is a very frustrating complication which can happen specially in dark coloured skin patients. The best course of action would be serial steroid injection in the scar:This will help with itchy sensation 7-10 days after the first injection. You will then need to have further injections at regular intervals of 6 weeks. It is important to stick with the schedule and do not miss an injection as it can come back. In well motivated patients that have the discipline to stick with treatment plan, the scar become gradually softer and paler and after a possible 4-5 injections it might be flat / soft enough to discontinue treatment.

Donald R. Revis Jr, MD · Answer

Good evening,
Probably the best bet this far out from surgery would be a surgical scar revision, followed by possible kenalog steroid injections and silicone sheeting postop in an attempt to prevent it from coming back.

Scott W. Vann, MD, FACS · Answer

You should see your surgeon to treat your keloids. Certainly simple steroid injections in the scar will eliminate or at least greatly improve your pain and itching. It will also soften and help flatten the scar. At some point a scar revision might be needed. Over the counter treatments are not enough at this point. Good luck.

Jonathan Heistein, MD · Answer

Hi. There is no automatic solution to keloids. Since it’s been two years, I would ask your surgeon to excise the scars and inject the area with steroids.  Even though your steroid gel didn’t work, this offers a better chance of success. Best of luck!

Daniel Barrett, MD · Answer

Dear Cola109,
for scars, I close all of my incisions in 5 layers and do not use absorbable sutures because they cause inflammation and worse scarring. I tape all of my incisions in the office visits once a week for six weeks after surgery to improve the appearance. After taping, I start my patients on a scar gel therapy for 3 months that they have to put on their incisions twice daily.You should discuss your concerns with your plastic surgeon as different surgeons have different approaches in scar management.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Antonios Mitsakos, MD · Answer

you may want to consider a steroid injection. you also need to be advised that it is likely that you'll need more than one sessions. as every treatment it does carry (minor) risks which you'd need to consider before deciding. please discuss with your doctor

Jeremy S. Hurren, BSc, MBBS, FRCS (Plast) · Answer

It is certainly worth trying topical silicone gel but once there is an established keloid it may not be very effective.Keloid scars often improve with steroid injections. Steroid injections will usually need to be repeated on a number of occasions over several months to a few years. There is no guarantee they will be effective and there are disadvantages like fat atrophy. Part of what makes your scar obvious is their pigmentation this may well persist following steroid injection.I advise you to consult a suitably qualified and experienced specialist such as a plastic surgeon.Best wishes.

Charles Durrant, MA, MBBS, FRCS(plast) · Answer

Keloid scarring is a difficult problem to treat. You have already tried silcone dressings so now it's time for the next step - steroid injections. Locally acting steroid injections (don't worry, they don't have any effect on the rest of your body) can soften and flatten the scars and can take away the pain and itchiness. Speak to a local plastic surgeon for further advice. Good luck