Divots and noticeable scarring - what would your recommend at this point? (Photo)

Hi NY. I am so sorry about your complications. I’m sure that your healing journey hasn’t been easy. I would address your concerns in multiple ways. Fat grafting can be done to improve the contour irregularities. In this procedure, we remove fat from a different area of your body, purify it and reinject carefully into these areas. I would also recommend a scar revision for the widened and scars with aggressive scar management with silicone scar therapy soon postop. Microneedling can also be done to treat scars. Finally the color of the scarring can be addressed with light therapy, IPL or BBL. A skilled aesthetic provider can help with this. Since your journey has already been hard, I highly encourage you to seek out a board-certified plastic surgeon specializing in surgery of the breast and body to hear your concerns and come up with a plan to reach our goals. I wish you the best!

Thanks for your question! I would suggest getting a second or third opinion. Freeing up some scar tissue and possibly adding fat could help with the divots. Good luck!

Our treatments use combination therapy to improve the epidermis and dermis. We see atrophic and hypertrophic scars, as well as scars that have hypo and hyperpigmentation. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to discuss the best treatment options for your type of skin. .

Best,
Dr. Karamanoukian
Realself100 Surgeon

Hi,

Thank you for the question.

Based on your photos, it does appear that your have unfavorable scarring and contour irregularities in the lower portion of the breasts following your breast reduction surgery.

There is a breast reduction revision technique that can help correct unfavorable scarring by removing the old scars and creating new finger scars without contour deformity.

I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon specializing in Breast Reduction and Breast Revision surgeries to further discuss your options, specific techniques, concerns and expectations. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.

I hope this helps.
Best regards, Dr. Karanetz

Dr. Irena Karanetz
Breast Fellowship-Trained
Board Certified Plastic Surgeon

I'm sorry to hear that you're still experiencing dissatisfaction with the appearance of your scars two years after your breast reduction surgery, despite undergoing scar revision procedures. Dealing with persistent divots and dark discoloration can be frustrating.
At this point, I would recommend consulting with plastic surgeon who specializes in scar revision and breast surgery. They can evaluate your scars and discuss potential options for improvement based on your specific concerns and goals.
Some possible approaches that the surgeon may consider include:
1. Additional scar revision surgery: Scar revision procedures can address these issues. This could involve techniques such as scar excision, tissue rearrangement, fat grafting, or laser therapy to improve the appearance of the scars and surrounding tissue.
2. Microneedling or laser therapy: These non-invasive treatments can help improve the texture and pigmentation of scars by stimulating collagen production and promoting skin regeneration. They may be beneficial for addressing discoloration and unevenness in the scar tissue.
3. Camouflage makeup or tattooing: In cases where scar revision surgery may not be feasible or desired, camouflage makeup or medical tattooing can be used to conceal the appearance of scars and create a more uniform skin tone.
4. Silicone gel or sheeting: These topical treatments can help flatten and soften scars over time, potentially reducing their visibility and improving their texture.
During your consultation, be sure to discuss your concerns openly with the surgeon and ask any questions you may have about potential treatment options, expected outcomes, and recovery. They can work with you to develop a personalized treatment plan that addresses your needs and helps you achieve the best possible results.

Divots and noticeable scarring can be quite frustrating but fortunately, options like scar revision surgery, laser treatments, and scar care may improve the appearance of scars. Fat grafting can fill in any divots and create a smoother breast contour. You would need to be examined in person for personal recommendations but these treatments may be helpful.

The areas of dips could be filled in with fat or Sculptra injections. If there is a lot of scarring there, fat may not work. I would suggest micro-needling and perhaps laser for the scars to lighten them.

I'm sorry to hear of the issues you've experienced from your breast reduction. It is best to give scars a year to mature and settle after the original surgery or any revision. I encourage you to meet with a few board certified plastic surgeons to listen to opinions. Another revision will be needed in order to improve your results.

If your breast reduction was two years ago and you’ve had multiple score revisions then how long has it been since your last scar revision? Scars can take 12 to 18 months before they stop changing
I generally recommend patient not have scar revisions within the first 12 to 18 months.
For undesirable scars it’s important to differentiate between scar hypertrophy and scar hyperpigmentation.
The two are two separate processes and should be addressed differently.
Mild hypertrophy is within the six weeks to three months.
At that point it usually reverses and begins to improve over the next year. Scar hypertrophy is severe to the point of almost being keloid like then very conservative. Steroid injections may be indicated.
The use of steroids should be selected for only the worst cases.
Inappropriate use of steroids has significant drawbacks side effects so they should only be used with great caution.
For mild hypertrophic scarring, silicone sheeting and avoiding any scratching or rubbing would be the first step. Silicon, tape or silicone sheeting should be used for as long as there is evidence of hypertrophic scar formation.
This process can take three months to nine months.
Hyperpigmentation is much more difficult difficult and does not seem to improve it with the use of silicon sheeting.
Hyperpigmentation usually improves with time and this can require a year and a half before scars are mature.
Chronic hyperpigmentation may respond to certain laser treatments.
Best,
Mats Hagstrom MD