Gynecomastia scars. What is the best way to treat them? (Photo)

Question

I had the Gynecomastia surgery done over the summer (August) and I'm wondering what the best way to treat the incision scars is and how long I should wait to do so.

Larry S. Nichter, MD, MS, FACS · Answer

Best Scar Management is important to minimize or completely hide from view, the telltale signs of your surgery—namely, scars. Both you and your surgeon want you to have the most minimal scarring possible. There are many possible causes for scars that are enlarged or not healing well. Unsightly scars are most commonly due to genetics, underlying medical conditions, or improper scar/wound care. The last part is very important and patients can make a noticeable difference in their scars’ appearance by following best scar management practices. Here are some simple tips.
Scar Management tips:
Minimize tension on the scar. Steri-Strips and/or surgical tape are often placed in non-hair bearing areas at the time of surgery to minimize tension and keep pressure over the scar.  This minimizes the  stress that  can pull the scar apart (dehiscence) creating a wound and  delaying healing time, and can make the scar wider, or more “ropy”. In the first few weeks after surgery, I recommend the use of Embrace Scar Therapy which is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar.Keep your incision site/scar clean to prevent infection. Follow your surgeon’s wound care instructions to the letter with out modification. Never apply different products then recommended without first discussing them with your surgeon. This is especially important during the first few weeks. If there are any signs of infection, contact your surgeon’s office right away and/or see your doctor or his nurse immediately. Typical signs of infection may include redness outside the immediate incision site, asymmetric swelling, and drainage, of pus, fever, chills, and “feeling sick”.Protect your scars from the sun. Staying out of the sun is the best advice. Minimal exposure to sunlight is prevents hyperpigmentation (permanently turning brown) and other problems that can make the scar more noticeable. Sunscreen, at least 30 SPF and an overlying make camouflage make up additionally protects the scar from the suns harmful rays. This advice is especially important the first year following your surgery.Use specific scar maturation products recommended by your surgeon. Patients seem to have their own opinions on this touting everything from Pure Vit E, Coco butter, to Aloe Vera, etc but most have minimal benefit other than keeping the scar hydrated. Although hydration is important there are better, scientifically studied products with greater efficacy. Most of the scientific articles written about this subject indicate that topical silicone gel or silicone sheets work the best. The best product available in my opinion is the Embrace Scar Therapy System by Neodyne BioSciences, Inc. available in many surgeons’ offices. Essentially this is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar. For areas that are not applicable for this product (e.g. smaller areas or on the face), I prefer BioCorneum or Kelo-Cote products There are a lot of products to choose from, but silicone should be one of the key ingredients. Although Mederma, an onion extract derivative active ingredient rather than mainly silicone based may help, primarily silicone based products are better and many also contain other ingredients that may be synergistic (hydrocortisone or other steroid, Vitamin E, Sunscreen, etc).. If the reader has problems obtaining these they can call my office. Patient compliance is also critical – use often and according to directions or it will not work optimally. NEVER apply products without first discussing them with your surgeon.Monitor to make sure your scar is progressing optimally. Keep your scheduled follow-up appointments with your surgeon to verify that your scars are maturing as expected.  Occasionally if indicated you may need a topical steroid preparation or even a series of  injections (5-FU and/or Steroids) or laser treatments  to treat or  prevent scar hypertrophy or keloid formation (red raised scars), or other topical medicines to treat post inflammatory hyperpigmentation (brown scars) with prescription creams and possible laser treatments.

Jed H. Horowitz, MD, FACS · Answer

BRUISING AND SWELLING: Bruising and swelling are normal and usually increase slightly after the removal of any tape or foam. The bruising will decrease over 3-4 weeks, but may last as long as 6 weeks. The majority of the swelling will be gone within the first 3-4 weeks. However, it may take 6-9 weeks to disappear completely. The compression garment helps reduce the swelling, and the longer it is worn, the more quickly you will heal.NUMBNESS: It is normal to experience numbness around the areola and chest. As your body heals, you may notice random bursts of pain in your chest. This is usually a sign that the numbness is subsiding.LUMPINESS: As you heal, the area may feel “lumpy” and irregular. This, too, decreases with time, and massaging these areas will help soften the scar tissue.ACTIVITIES: If your work keeps you sedentary, you may return whenever you feel up to it. If your work is strenuous, wait until your work activity does not cause pain. Wait at least 4 weeks to begin aerobic exercise.Often the question is asked of what will the scars look like? Following surgery, your incisions will go through a maturation process. For the first few months they will be red and possibly raised and/or firm. As the scar matures, after 6-12 months, it becomes soft, pale, flat, and much less noticeable. You may experience numbness, tingling, burning, “crawling”, or other peculiar sensations around the surgical area. This is a result of the healing of tiny fibers which are trapped in the incision site. These symptoms will disappear. Some people are prone to keloids, which is an abnormal scar that becomes prominent. If you or a blood relative has a tendency to keloid formation, please inform the doctor.As with all operations, pain and discomfort varies greatly from patient to patient. Generally, one should expect that pain medication will be required for the first several days. Continuing discomfort can last varying amounts of time. The best thing to do in order to receive answers for post-operative healing is to visit your surgeon and have the area examined to make sure that everything is progressing as it should or if any corrections or revisions are needed. Good luck.

Ronald Schuster, MD · Answer

Check with your surgeon for his/her recommendations. I usually have my patients use silicone tape for three moinths.

Sean Doherty, MD, FACS · Answer

It can take up to a year for scars to fully resolve so part of the process is just being patient. However, silicone tapes and gels can help if there is a problem. My best advice would be for you to schedule an appointment with your surgeon to have your scars examined and then talk best options. Hope this helps.

John D. Smoot, MD · Answer

Thank you for your question and the best treatment is massage and scar creams but the way your body heals will ultimately determine how your scars will look.  The best time to treat scars is in the first six months beyond that there is little that can be done but I would follow your surgeons instructions.

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