Any suggestions on the scars after Breast Reduction? (photo)

These are my scars 6 months after breast reduction. They are extremely painful and think and raised. I don't normally scar like this, and have never had scars like this before after surgery. What could have gone wrong. Also the scars are not in the inframammary fold, and I thought they were going to be. Is this type of scarring normal 6 months after breast reduction surgery?

Doctor Answers 3

Scar Management

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:
  1. 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.
  2. 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”.
  3. 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.
  4. 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.
  5. 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.

Hypertrophic scars

Looks like very red hypertrophic scars .  I would suggest kenalog injections to try and soften them.  You may need a surgical revision.   Best to see a board certified plastic surgeon for best advise. 

Andrew T. Cohen, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 37 reviews

Scars after breast reduction

Your scars are clearly worse than typical, and would be described as hypertrophic scars.  Scar hypertrophy often occurs due to genetics, and can be worsened by increased tension on a wound closure, healing issues, infections, or other problems.  Surgical technique can be a factor, but most often this is not the main issue if you have a skilled surgeon.

The good news is that scars tends to improve over time, so they will probably flatten more, and the pink color should fade.  In the meantime, daily scar massage and UV avoidance are the minimum you should be doing to help the scars.  Kenalog (steroid) injections can also be helpful.  There are products that can improve scarring such as Embrace silicone sheeting and Biocorneum topical silicone, although these products help more in the early phase after surgery.  These products will be important if your scars don't improve enough and if you choose to have a scar revision at some point in the future (it's usually best to wait at least 6-12 months after the original surgery).  I would recommend that you see your surgeon and discuss options to make the scars better.  Good luck!

Robert Cohen, MD
Santa Monica Plastic Surgeon
5.0 out of 5 stars 40 reviews

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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.