Is a reduction from H to D with a history of keloid scarring a realistic surgery for me?

The cup size measure has inherent variability.  Tissue density will always play a big role in the number of grams removed.  Going too small can sacrifice the shape of the breasts.  After breast reduction, your belly, legs, and arms will appear bigger than before the surgery.  The nipple has to have a blood supply to survive from the underlying tissue.  You can always tighten the skin later if not aesthetically pleasing, and breast mass will decrease with time.  In general, scarring is a product of genetics. For keloid formers, there is not a way to prevent keloids.  In general, the longer the scar or the greater the number of scars, the greater the chance for keloids. I always minimize the scars to minimize the likelihood of poor scars. The keloids may require multiple modalities to achieve the best results.  Laser may help to some extent with some types of scarring issues. 
As an author of Scars and Scar Revision in Reoperative Plastic and Reconstructive Surgery, I am well versed in the potential treatment options.  One treatment may be helpful for one patient while another treatment may help another patient.There is no one best therapy for scars. Silicone sheets, Mederma, and Bicorneum are reasonable and popular options. I recommend that the scar therapy begin after the scars have healed and there are no open areas, which usually takes 4 - 6 weeks.
Consult with a board certified PS who performs hundreds of breast procedures each year to discuss your candidacy for the BR, the pros and cons of BR, and the most appropriate time for you to have the surgery.
Kenneth Hughes, MD, ABPS Board Certified Plastic Surgeon
Los Angeles, CA

Thank you for your question.It is difficult to say for sure without pictures, but you would probably need a anchor shaped scar ("wise pattern"). Limited incision reduction which leads to less scarring may not be an option. Breast Reduction is very gratifying surgery for both the patient and the surgeon but the scarring and kelloid formation can be an issue. Please find an experienced Board Certified Plastic Surgeon near you who can help you with your concerns. All The Best !

Most women find the trade offs (scarring, perioperative pain) are far and away worth the benefits (decreased back pain, neck pain, shoulder pain)You need to clarify your history of scarring with your PS.  Many patients dont have keloids, but hypertrophic scarring, which is easier to manage.  Either case, these scars can usually be managed well to make the procedure worth the risk.  

Thank you for your questions. In short, the answer is yes, a breast reduction procedure can take you from an H cup to a D cup. And keloid scars can be a problem but there are several scar management remedies that can help. I would make sure that you are seeing a plastic surgeon who is board certified by the American Board of Plastic Surgery for a consultation!Good luck!Dallas R. Buchanan, MD, FACSOwner & Board-Certified Plastic SurgeonVIVIFY plastic surgery

Thank you for your question. This is a common concern of patients of mine. I would make sure you see a board certified plastic surgeon who has experience with treating keloids, and experience in performing procedures on patients with dark skin tones. Suture type is important, surgery style is important and post op care is important when trying to prevent and treat keloid scarring.

Hello!
Thank you for your question. Tissue density will always play a big role in the amount
of tissue (and the number of grams) that can be removed. Going too small can
sacrifice the shape of the breasts. The nipple also has to have a healthy/robust
blood supply from the underlying breast tissue in order to survive. A plastic
surgeon cannot guarantee that a breast will be a specific cup size after breast
reduction surgery. In general, very large breasts are rarely reduced by
more than two or three "cup" sizes. Breast reduction surgery may help
alleviate some neck/shoulder/ back pain, infections under your breasts, and bra
straps embedding in your shoulders. 
As for your keloids, it is important to remember that there is not-insignificant incisions/scarring with a breast reduction. Each millimeter of scar is at risk for keloid-ing. However, there are ways to reduce (but not remove) this risk. (But this is beyond the scope of this Q&A and is best addressed by your plastic surgeon.)
Keep in mind that if you
decide to pursue surgery it’s very important that you find a surgeon whom you
are comfortable with and trust and who evaluates you
in-person, addresses your concerns, and tailors an individualized treatment
plan for you and your aesthetic goals. Best of luck!
Matthew
A. DelMauro, M.D.

Thank you for the question. Based on your description you may be an excellent candidate for breast reduction surgery.   However, much more information is needed to determine whether you should proceed with surgery, and if so when (timing).   


“Typical” patients who present for breast reduction surgery are women who have disproportionately large breasts, causing problems such as neck/back/shoulder discomfort, postural changes, bra strap grooving, skin irritation/rashes under the breasts, and/or difficulty with activities of daily living and/or exercise etc. There may be both physical as well as psychosocial “stress” caused by the disproportionately large breasts.


Reducing breast tissue mass and elevating the breasts on the chest wall tend to improve or alleviate many of the symptoms associated with the disproportionately large breasts.


Patients considering breast reduction surgery should also consider the potential downsides (risks/complications) associated with the procedure as well.. Poor scarring, for example may be associated with the procedure.  Additional surgery may be necessary in the short or longer term for a multitude of reasons.


When the time is right, I would suggest starting with the American Society of Plastic Surgery and/or the Aesthetic Society of Plastic Surgery to obtain a list of well experienced board-certified plastic surgeons.
Then, I would suggest you visit a few surgeons whose practices concentrate on aesthetic surgery. Ask to see lots of examples of their work and preferably speak/see patients who have had similar procedures done.


Then, it will be important that you communicate your goals clearly with your plastic surgeon and make sure that you have realistic expectations prior to proceeding with any type of surgery. In regards to breast size desired, also communicate carefully. In my practice the use of goal pictures are helpful in this regard; a discussion of cup size can be confusing and imprecise.   Therefore, I would not suggest that you communicate your goals and/or base your satisfaction with the outcome of surgery on achieving a specific cup size.  I also find that the use of pictures is more helpful than the words “natural” or "proportionate” or "D cup" etc., which can mean different things to different people.  Having said the above, in most cases significant reduction (for example down to a C or D cup) is usually possible.


Many of my patients choose to have enough breast tissue removed to help alleviate symptoms while retaining enough breast tissue to remain proportionate to the remainder of their torso.


I hope this helps.

Thanks for writing,Many times people tell me they form keloids when in reality they only have hypertrophic scar. These are two different animals. Find a Board Certified Plastic Surgeon who can help you understand the difference and therefore make an accurate decision on how to precede. Good luckStephen M. Davis, MD, FACS 
Certified: American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery
Member: American Society of Plastic Surgeons
Member: RealSelf Hall of Fame

Hi and welcome to our forum!
You note the presence of keloids in the past. Are they active, or did they regress (in which case they may have been hypertrophic scars instead)? 
If you are experiencing neck pain, back pain, shoulder pain, chest heaviness, bra strap grooving, or chronic rashes beneath the breasts due to your breast size, it may be worth the risk to undergo correction.
Size H to size D breast reduction will most likely require a full "boat anchor" incision. Postoperative care may involve intensive wound care until all incisions are sealed, silicone gel sheeting application to the healing scars, and immobilization / support of the breasts for at least a year. Some advocate laser or superficial radiation treatments if recurrence is noted. 
Seek evaluation and advice from a board certified plastic surgeon.
Best wishes...