Raised Breast Incision Scars, Do These Look Normal? (photo)

Scarring is a natural process with several distinct stages.  In the first 2 weeks the body is fighting any left over bacteria and starting to signal the building blocks and blood vessels to come to the area.  During this time the scar is very weak and the skin could be split very easily. Generally the scar is not red or pink yet.   From  weeks 2-6 the scar has more and more building blocks (collagen) laid down.  During this time the scar can become more raised and more pink/red.  From 6 weeks till one year the scar is in the "maturation phase" during this time frame the building blocks are being remodeled into a strong wall rather than a big pile.  The organization of the collagen allows the scar to become stronger while at the same time decreasing the overall amount.  At the beginning of this phase the scar is pink but it slowly starts to fade and the raised scar starts to flatten out.

Several treatments are suggested for the treatment of scars some of which work some which have no real science behind them.  In general I tell my patients most scars will mature on their own without any intervention but some people want to do something.  I recommend anyone see a medical professional to get their advice before initiating any of the following treatments.

Vitamin E- I have never seen a study that proves vitamin E improves scar appearance and some people (2%) have an allergic reaction to the topical vitamin E oils. 

Silicone and Mederma-  Mederma is a brand of liquid silicone.  In general we do not understand exactly how silicone improves scarring but it does work.  The theory is that the silicone helps the collagen to line up more.  The effectiveness of the silicone is related to the thickness of the silicone over the scar.  Therefore I recommend solid silicone sheeting rather than the liquid form.  The silicone needs to be on the scar pretty much 24 hours a day to be really effective. 

Scar Message- rubbing firmly on the scar from about 1-3 months after the injury will help to break up the raised scar.  It should be done several times a day to be effective. 

Cocoa Butter- no real value to improving scarring but it is some times used a moisture during scar message. 

Tape- Tape can act to support the scar and take some of the tension off the incision.  This will allow the scar to mature more quickly and possibly be thinner.  The ideal time frame for taping is from the time of the incision until 6 weeks later.  Some people can have allergic reactions to the adhesive especially when it is in place for such a long time so it should be used with caution.

Steroids- local injection or topical application of steroids can improve the appearance of a hypertrophic (larger than expected) scar.  Only certain scar types at certain stages benefit from steroids not all scars.  There are many side effects to using steroid which can make the overall appearance worse not better.  These side effects include thinning the surrounding skin and atrophy of the surrounding fat.   Only a medical professional should recommend and treat with these products.  

Thank you for your question. Breast incisions can be managed using a multimodal approach:
1) Scar massage - starting as soon as the surgical dressings come off and the incisions are sealed
2) Silicone sheets or scar gels for about six months to year
3) Embrace - a tension reducing dressing for the first 2 months
4) Fractionated lasers to help blend the scar into the background - done as a series, starting about 4 weeks after surgery and repeated every four weeks for six months.
5) Sunscreen to prevent the scars from darkening

It’s normal for scars to be red and slightly raised 6 weeks
following breast augmentation surgery.In the vast majority of patients, this gradually improves over the
course of time. It’s
important to realize that scarring is inevitable after any surgical
procedure.When breast augmentation is
performed, every effort is made to hide scars where they won’t be noticeable.Incisions are typically hidden in the armpit
beneath the fold of the breast and at the junction between the areola and the
surrounding skin. Unfortunately,
in rare cases, adverse scarring can occasionally occur.This is usually due to wound healing biology
and is frequently seen in patients with darker pigmentation. It’s
important to remember that wound healing continues for over a year after a
surgical procedure.During this phase of
wound healing, there are several maneuvers that can be performed to minimize
scarring.These include mechanical
massage, the use of Silastic sheeting and topical agents such as Mederma.Even when these methods are used, scarring
may still be a problemIf
scars have failed to improve after they have reached maturity, scar revision
may be an option.If you’re concerned
about scarring, you should consult with your plastic surgeon.Your surgeon will be able to recommend an
appropriate course of action.