Pain and horrible scaring 14 months after breast augmentation - is there any non-surgical way to make scarring better?

It must be frustrating to still be dealing with raised, red, and painful scars 14 months post-op. Typically, by this stage, most scars have started to fade and flatten, but some people do experience prolonged healing issues, including hypertrophic or keloid scarring. Let's explore why this might be happening and what non-surgical options you can consider.

Why You Might Still Have Raised, Red, and Painful Scars:
Hypertrophic or Keloid Scarring: Raised scars that are red and sometimes painful are often due to hypertrophic scarring (raised but within the boundaries of the incision) or keloid scarring (raised and growing beyond the incision area). Some people are more prone to these types of scars due to genetics or individual skin healing tendencies.

Poor Healing from Wound Complications: You mentioned that your incision on the left breast opened up. When incisions open during the healing process, it can lead to more significant scarring as the body tries to repair the tissue. This could explain the scarring on your left side.

Inflammation or Infection: Sometimes prolonged redness and pain can indicate chronic inflammation or a mild infection at the scar site. If there's persistent pain, it's important to rule out any ongoing inflammation.

Non-Surgical Ways to Improve Scarring:
While scars may never completely disappear, there are several non-surgical treatments that can significantly improve their appearance and reduce pain:

Silicone Sheets or Gels: These are considered one of the most effective over-the-counter treatments for raised scars. Silicone helps flatten scars, reduce redness, and improve overall texture. You can apply silicone sheets directly to the scar or use silicone gel, which can be worn under clothes.

Scar Massage: Gentle, consistent massage of the scar can help break down excess collagen in the scar tissue, reducing its raised appearance. Use a lubricant or moisturizing cream while massaging the scar for several minutes each day.

Corticosteroid Creams or Injections: If your scars are hypertrophic or keloid, corticosteroids can help reduce inflammation, redness, and pain. Your doctor can prescribe a topical steroid cream, or they might suggest steroid injections directly into the scar to help flatten it over time.

Laser Therapy: This non-invasive treatment can help reduce redness and flatten raised scars. Laser therapy works by targeting the blood vessels in the scar to reduce redness or stimulating collagen remodeling. Multiple treatments are usually required for the best results.

Microneedling: This technique involves tiny needles that puncture the skin to encourage collagen production and promote skin remodeling. It's often effective for improving the texture of scars over time.

Pressure Therapy: Wearing pressure garments or applying pressure to the scar with bandages can help prevent and flatten raised scars. This is more common in keloid or hypertrophic scar management.

Silicone and Vitamin E Creams: While vitamin E is somewhat controversial in its effectiveness, some people find it helpful when combined with silicone-based treatments. Vitamin E can be moisturizing and may help soften scar tissue.

Tretinoin or Retinol: These topical treatments are often used for skin rejuvenation and can also help improve the appearance of scars by promoting skin cell turnover and collagen remodeling. A prescription might be required for tretinoin.

Painful Scars:
Since you mentioned that the scar is painful, it could be due to ongoing inflammation or nerve involvement in the scar tissue. If this continues, it’s important to discuss the pain with your surgeon or a dermatologist, as they may suggest more targeted treatments like steroid injections or nerve pain relief.

When to See a Doctor:
If you haven’t done so already, it would be helpful to consult with your surgeon or a dermatologist to rule out any underlying issues, like infection, or to discuss more intensive treatments like steroid injections or laser therapy. They can help evaluate whether the scarring is abnormal for your stage of healing.

In the meantime, starting with silicone sheets or gels and scar massage may provide some relief and start the process of improving the appearance of the scars.

There are several treatments available for scars. An examination would be needed to give specific recommendations, but you may be a candidate for steroid injections which can help with raised scars. Other treatments include lasers, silicone sheeting, and scar creams. If necessary you can consider scar revision where the previous scar is removed.

You did not post photos so I cannot tell if you have keloids or hypertrophic scarring. However, you can go back to your surgeon and have the scars injected with Kenalog, a steroid to get them to calm down. You may need more than one visit.

To make an assessment on the outcome of a plastic surgery procedure we generally always need to see a complete set of the proper before and after pictures. Without seeing pictures, we can’t begin to make an assessment. Skin incisions are usually mature and stop changing 12 to 18 months after surgery. For most patient scars are fairly close to maturity by a year.
I suggest you follow up with your provider or schedule in person second opinion consultations.
Best,
Mats Hagstrom, MD