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

Question

I had a breast augmentation almost 6 weeks ago i am yet to see my surgeon again, I am abit concerned about the scars i have crease scars and since day 1 they have been low down not really in the crease and it feels like there is a thick line of scar tissue underneath the scars and it is making it look like i have double bubble but i dont think that is what it is as the breast feel fine,i have silicone brazilian breast implants, under muscle left side 380cc and right side 435cc high profile.

Chad K. Wheeler, MD · Answer

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.

Young R. Cho, MD, PhD · Answer

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

Richard J. Bruneteau, MD · Answer

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.

Lewis Albert Andres, MD · Answer

Hello! Thank you for the question!  The typical incision used for breast augmentation are: inframammary (in the fold beneath your breast), periareolar (at the border of the areola), axillary (within the armpit crease), and TUBA (through the umbilicus). Incision placement will do a lot with your preference, surgeon comfort level with that approach, and the type of implant - silicone implants will be difficult to place within certain access incisions. Breast augmentation scars are well concealed and are very discrete. They should not be visible within clothing, and likely hidden without clothing. If your concern is the visibility without garments, you should consider remote access incisions such as in the armpit. However, these other incisions heal very well on the breast and often times inconspicuous. It is common for scars to fully mature for up to a year. In the meantime, there are a few things that may help to ameliorate your incision/scar. The most proven (as well as cheapest) modality is simple scar massage. Applying pressure and massaging the well-healed scar has been shown to improve the appearance as it breaks up the scar tissue, hopefully producing the finest scar as possible. Other things that have been shown to add some benefit, albeit controversial, are silicone sheets, hydration, and topical steroids. In addition, avoidance of direct sunlight to the incision will significantly help the appearance as they tend to discolor with UV light during the healing process. If unsightly scars are still present after approximately a year's time, other things that your surgeon may consider are intralesional steroid injections, laser, or just surgical revision of the scar itself.Consult with a plastic surgeon your goals, concerns, and expectations. Certainly incisions should be considered, but should not limit your overall result by hindering visualization and access to your surgeon, and what produces the best results in his/her hands.Hope that this helps! Best wishes!

Ankit Desai, MD · Answer

Scars should continue to improve for several months. Remodeling of the collagen begins after several weeks and the scar matures flattens and then turns from pink to white. Give it some more time and consider paper tape, scar massage, or silicone gel formulations to maximize your scar quality.

Douglas L. Gervais, MD · Answer

Your scars appear to be healing as expected at 6 weeks. It is not uncommon for scars to be slightly raised or red. They often get worse before they get better as well. Be patient, scar remodeling can take many months and even up to a year. Follow up with your surgeon and they will guide you if any scar intervention is needed.

Jennifer Lauren Crawford, MD · Answer

The appearance of a scar at 6 weeks is frequently slightly raised and red looking.  It will take a year or more for your scar to completely soften, fade, and flatten.  However, some people do form hypertrophic (permanently thickened) scars that can benefit from treatment.  If your surgeon recommends it, I would use topical silicone either in the form a small sheets placed over the scars or a gel form used daily over the next 2 or 3 months. 

	I will also tell you that it may be another month or so before your implants completely settle into their pockets.  So, you may find that your scar ultimately ends up in the crease under your breast.  Please consult with your surgeon about this and have that person follow your progress.  I have patients perform implant massage a few times a day starting 1-2 weeks out from surgery to help keep the implants mobile and perhaps encourage them to settle faster.  Check with your surgeon to find out if this is something he or she recommends.

Don W. Griffin, MD · Answer

Your scar position will continue to change with time. The line of scar tissue that you feel under the incisions is normal for this point in time and usually always disappears in a few weeks. Continue to follow-up with your surgeon.

Michael M. Omidi, MD, FACS · Answer

Thank
you for the question.  You are still in
the post operation recovery stage.  It is
not uncommon to feel pain, itchiness, and swelling during this
period. Scars should fade away in time but not to a 100%.  It usually takes about 8-12
weeks for the wounds to heal and around 4-6 months for the implants to fully
settle.  It would be best to visit your
board-certified plastic surgeon and get a full assessment for your concerns.  Best of luck. Dr. Michael Omidi.

An
in-person exam with a board-certified plastic surgeon is the best way to assess
your needs and provide true medical advice.

Steven Wallach, MD · Answer

At six weeks, the scar is often firmest and reddest. Give it time to settle and for the breasts to settle. It is still a bit early.

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

Answers (13)

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