Is It Okay That my Periareolar Incision Looks Like a Crease Incision? Whats the Best Way to Heal the Areola Scars? (photo)

Question

Im post op 2 weeks. My ps told me i can take off the bandages whenever i feel like. So i did last night. Im a little concerned. My areola incision is not around my nipples but its a line right under my nipple. It looks like i had a crease incision on my nipples. I believe its because the silicone implants are too big and im very petite so he didnt have a choice but are they gonna blend in the future? Also there is still blood on my scars. Do they look like they are in a normal healing process?

Kurtis Martin, MD · Answer

Your incision looks normal for 2 weeks with no signs of problems. However, it appears the incision veers away from the areola medially. The incision should follow the areola in a more superior direction. My guess is the surgeon extended the incision during the surgery and there were no marks to follow on that part of the areola.

Luis Villar, MD, FACS · Answer

It is too soon to worry and too soon for definitive advice.  In 3 to 6 months you should have a good idea of the  quality of your surgery and/or your wound healing genetics.

	In adults a wound may take 12 to 18 months to reach full maturity with soft pliable tissue and recession of capillary ingrowth.  You are now in the collagen formation and wound contraction phase of healing which produces a red, rubbery, immobile scar mass peaking at about three weeks, plateauing for weeks or months and remodeling as the wound matures into some form of soft, pliable, white scar.  The process and result is guided by your genetics.  It is prudent to defer revisions until the wound has matured.

	In short.  Be patient.

Vincent N. Zubowicz, MD · Answer

Because of the nature of the areolar tissue swelling can translate into unusual contour and shape issues. They are self-limited and will improve as swelling subsides.

David Bogue, MD · Answer

There are multiple issues to mention in your case. Firstly, the "nipple" incision is made at the border of the areola or slightly inside the areola. In the photos provided, it does appear that the incision went a bit wide on the right rather than following the curve however these are not the best photographs. It is difficult to see your areolar size overall in relation to the breast. Some patients simply have areolas preoperatively that are too small for this type of incision. Scarring also takes time. At two weeks, you have very rudimentary scars. The sutures are still providing the majority of the strength to the closure. It will take another month before the scars have been sufficiently made and at least a year before they have finished maturing. Most peri-areolar scars do quite well. Your plastic surgeon may advise you on scar management techniques such as massage or the use of silicone sheeting. Keep your follow up appointments and stick to the postoperative routine. The worst case scenario would be a scar revision in the future to improve the appearance.

Steven Wallach, MD · Answer

Your incision along the areola border does look like it did not follow the natural contour of the areola.   Its appearance may improve with time.

Benjamin Chu, MD, FACS · Answer

It looks like the incision initially followed a portion of the periareolar boundary but drifts away from the edge of the areolar laterally especially on the right side. You implants also looks quite high. My guess is that the incision was initially marked as a certain length incision and when the very large implants were introduced it did not fit so the incision had to be lengthened. Lengthening the incision during surgery may be more difficult since with lighter areolas the margin is more difficult to see after the surgery has begun. So the incision does not follow the border of the areola precisely. The other explanation is that trying to insert a very large implant into a smaller incision can cause the skin to tear in places other than the planned incision. The use of the Keller funnel can be a great help to reduce tearing of the smaller incision with larger implants because it does not stretch the skin as much. Finally the stitching can affect the appearance of the incision. The skin edge looks puckered or indented in several places. This is related to placing subdermal sutures too close to the epidermis and pulling a bit of epidermis downwards causing a dimple. This will eventually subside but can be bothersome to patients since it looks untidy. Most patients expect plastics surgeons to suture flawlessly.

Jourdan Gottlieb, MD · Answer

I understand what you are saying, but I can't quite see where the pigment of the areola ends on the photos, so these may well be at the edge of the areola except, perhaps at the ends. They appear to be healing normally at two weeks.

	All the best.

Alan M. Engler, MD, FACS (retired) · Answer

It looks like it's healing well at this point and there's also not much you can do about the location of the incision.  It does appear to go beyond the areola/skin junction laterally but I think this will heal well and not be very noticeable.  You should of course discuss this with your own PS

	I hope that this helps and good luck,

	Dr. E

Is It Okay That my Periareolar Incision Looks Like a Crease Incision? Whats the Best Way to Heal the Areola Scars? (photo)

Answers (8)

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