Can cortisone injections into keloid scar from breast aug cause skin to thin to the point where implant can break through skin?

Question

I got a breast augmentation and needed a lift on one breast. My skin was already a little thin with little elasticity. I had a full anchor lift on the left side and the outer scar became a keloid scar. I got cortisone injections to flatten the scar but then I noticed a change in the appearance. The skin is bulging and seems bluish and painful and rippling. My implant should be under the muscle, I went to see my dr and she said I need to have surgery to get rid of the thin skin. Is this accurate?

Richard J. Restifo, MD · Answer

Yes, cortisone can definitely lead to thinning of the skin and if it appears blue it usually means the implant is just under the skin. When an implant is placed "under the muscle" this means that the upper half of the implant is under the muscle but the bottom half is not, because the pectoralis muscle stops at about the level of the nipple. If an implant breaks through the skin often it is necessary to remove it and wait six months before replacing it, so it is often a good idea to be proactive if the implant is very close to the surface. Best wishes.

Kenneth Hughes, MD · Answer

Side effects of using cortisone injections include thinning or sunken skin at the injection site.  Steroids are known to break the bonds between collagen fibers, which reduces the amount of scar tissue beneath the skin. Your PS has the benefit of seeing you in person so I would follow her advice regarding removal of the thin skin.

Farbod Esmailian, MD · Answer

Thinning is a potential side effect of steroid injections, and this is well known.  That is why it always needs to be factored into the equation.It is difficult for us to tell what is going on, but if your surgeon feels that removing the skin is the best approach then I would follow his/her recommendation.  From what you are describing I would say that the bulging and the bluish appearance is somewhat worrisome.Hope that helps.

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question. It is possible to have sufficient cortisone injected that it can thin your skin tissues.  If an impending implant rupture is possible, it would be best to have the skin excised and healthier skin closed over top.  Now without the tension of the lift you may see a lowered risk of keloid formation.  Hope this helps.

Daniel Barrett, MD · Answer

Dear Michellekro,I understand your concern. However, without a proper assessment it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after thorough examination you can get proper recommendations and advice.Daniel Barrett, MD

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Can cortisone injections into keloid scar from breast aug cause skin to thin to the point where implant can break through skin?

Answers (7)