I am a 62-year-old black female. I have formed keloids from breast reduction surgery. The keloids are on the surgery site. I do not particularly want to go back into surgery. I am interested in any non-surgical procedures, especially any new ones.
Non-surgical Revision for Breast Reduction Keloid Scars?
Doctor Answers 16
Keloid scar - One Tough Problem
Keloid scars can be a tough problem. It is first very important to differentiate between a hypertrophic scar and a keloid scar. The treatment for each type is quite different.
A keloid is a progressive growth that extends past the original scar and invades and destroys normal skin and tissue. A hypertrophic scar is just a widened, thick scar due to excessive tension. These are common on the upper back, between the breast and upper arm. These are all areas of excessive tension.
The stimulus for a keloid is inflammation. Anytime the skin is injured, from a cut, incision, or infection the healing process is started. This involves a complex array of cells. Early in the healing process, mast cells release histamine. This histamine attracts fibroblasts. Fibroblasts are the cells responsible for the production of collagen. Collagen is the body’s building block for scar formation.
In the typical individual, this histamine signal is turned off at about 6 weeks. For the keloid former this signal never stops. This is why a keloid scar itches. It is a response to the histamine reaction in the skin. More and more scar tissue is formed and formed abnormally in the keloid patient.
A good way to explain this is to consider a wound like a construction site. Normally there is an initial flurry of activity as more material and equipment are brought in to perform the various tasks. For a scar, this peak of activity occurs at about 6 weeks.
Next, the body makes enzymes that remodel the scar bringing it down to its final appearance. This is why all incisions and wounds initially appear inflamed, and then they become thick, hard, red and raised. This reaches a peak at 6 weeks.
The final phase of wound healing is maturation where the scar is remodeled and eventually reaches is final matured version. There has really been very little that is new in the treatment of this condition over the past 20 years.
The standard treatment protocol involves:
- The injection of Kenalog which is a steroid
- 5 FU - 5-fluorouracil
For the difficult recurrent or refractory keloids I usually suggest the following treatment protocol:
- Excision of the keloid, under minimal tension, using suture material that dissolves by hydrolysis and not by inflammation. The synthetic suture material dissolves by hydrolysis while the non-synthetic material such as chromic dissolves by inflammation.
- At the time of excision you can consider injection with a Steroid such as Kenalog and the addition of a chemotherapeutic agent such as 5 FU. There have been several recent studies discussing the benefit of this additional drug therapy to the management of keloids.
- Taping of the incision immediately after the procedure reduces overall tension and can be beneficial
- Silicone gel sheeting has been advocated
- Codran tape - this tape contains Flurandrenolide which is a potent corticosteroid for topical use
- Radiation can be effective; typically the incision will be treated with a low dose of radiation about 2 days following the excision of the keloid. Any incision, to remove a keloid, can start the whole process over again.
A good evaluation by a plastic surgeon and a keen understanding of the process of keloid formation can help correct the problem, or at least make it better.
Non-surgical treatment of keloid scars
The standard non-surgical approaches to keloids are:
- pressure therapy
- topical silicone gel sheeting
- intralesional steroid injections
- radiation therapy for severe and recurrent forms
The pathophysiology of keloid formation is poorly understood and as a result, treatment of this problem can be very difficult. When keloids occur following surgery, non surgical methods of treatment should be used first because surgical revision is associated with a high recurrence rate.
A variety of non surgical methods have been used to treat post-operative keloids. These include massage, silicone scar sheeting, pressure, steroid injections and rarely radiation therapy. Despite the availability of multiple non surgical treatments, keloids continue to have a high rate of recurrence.
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Bra Reduction - Keloids on Scars
I'm sorry that you're having this problem...keloids remain one of the most vexing problems in plastic surgery (as well as other surgeries, and even just as a result of trauma). Their genesis is poorly understood, and their treatment is frustrating. Non surgical methods include pressure, occlusion with pads (such as silicone) and steroid injections, but with firmly established keloids, none of these is typically successful. Surgery is effective in removing the scars, but there is then the issue of preventing their recurrence. Steroid injections and radiation have been described as adjuvant therapies but, again, with varying success.
I wish I had a simpler and better answer than that!
Breast Reduction and Keloid Scars?
Thank you for the question.
Sometimes the use of silicone-based products and/or steroid injection may be helpful. The use of superficial radiation treatment is possible for symptomatic scars. Sometimes scar revision surgery and careful scar management afterwards may be helpful. Despite anecdotal reports otherwise I have not seen significant improvement with laser treatment of scars.
Improving keloid and hypertrophic breast scars
The first stage of scar management, whether keloid or hypertrophic, should be non-surgical. These treatments include injection of TAC, massage, silicone sheeting, and observation. If you have unsightly breast scars, you may be a candidate for non-surgical scar management.
Keloids can be improved with multimodality therapy, but sometimes surgery is required. Surgery90210
Keloid treatment options
If you have fully formed keloids, then usually surgery is recommended along with one of many modalities (steroids, radiation). Taping, silicone sheeting, steroids really only help to prevent them before they grow or help in only moderately raised scars.
Keloid scarring options
There are several options, but nothing ideal for everyone:
1. You can use silicone sheeting - chance of imptovement: minimal
2. You can use cordran tape (cortisone tape) - chance of improvement: minimal to moderate
3. You can use steroid injections - chance of improvement: moderate
4. You can use laser - chance of improvement: moderate
5. You can use radiation - not advisable in the breast area
Kenolog and 5FU injection for keloid scars
Talk to you doctor about using a combination of kenalog and 5FU. There was a recent article in the plastic surgery journal regarding this treatment. I have used this for more than 10 years.
Response to your keloid comment
I will respond to your comment, as others have addressed your original question adequately. There is no breakthrough for treating this vexing and frustrating condition. See your board certified plastic surgeon for a discussion on treatment of keloids. My protocol is:
1. Serial Kenalog injections with pressure and/or silicone application.
2. Excision with either Kenalog injection or radiation.
Of course any surgical removal may invite worsening of the keloids. However, incision tension is known to contribute to keloid formation and surgical incisions for the keloid removal would likely be under less tension than the original incisions for your breast reduction surgery. Good luck!