Should I opt for scar revision on my breast augmentation scars? (photos)

Question

I had breast augmentation with crease incision silicone 450ccs right breast, 425ccs left breast, about 1.5 year ago. unfortunately, My scars appear hypertrophic to me and much worse than any of my friends' scars who have had the same surgery. I also have pain in my scars, especially when on airplanes or when it's raining outside. Does anyone have any recommendations for surgeons in the California Bay Area who specialize in this type of surgery? My surgeon is not in my area since I have moved.

Raffy Karamanoukian, MD, FACS · Answer

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars. 
 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Martin Jugenburg, MD · Answer

At 1.5 years postop it is unlikely your scar will change without a revision.There is always the risk of the scar recurring. Consult with a board certified plastic surgeon in your area to discuss your options.

Scott W. Vann, MD, FACS · Answer

You would probably improve a lot with a scar revision. Some times the new implant causes a lot of pressure and spreads the scar. Now that your skin is accustomed to the implant, hopefully your scar will do better. Of course there is always the risk of the scar recurring. Most all plastic surgeons do good scar revision work. Good luck.

Amy T. Bandy, DO, FACS · Answer

I agree 100% with Dr. Rand, the scars are on your breasts because the implants have bottomed out, and the pressure from the implants is widening the scars and this can contribute to the tenderness you have.  Good luck!

Thomas Trevisani, MD · Answer

Scar quality has many factor including location and stress on the incision. Scar revision for you would be beneficial if this would help you feel better about your situation. Keeping in mind that even a scar revision can not guarantee recurrence of your widening of your scar.

Stephen J. Ronan, MD, FACS · Answer

Follow the link below to the second column, second row to see a case just like you.  This is a very common case in my office.You implants are bottoming-out due to an unfortunate release of your muscle.  This is continue and cause more drooping with time.  You scar was probably placed below your fold when it was made.  The implant has slid so far downward the the fold is now far below the fold.  This has now caused your nipple to rotate upward, well above the middle of the implant (they should be highest middle, best slightly below middle).  Your implants are now as much on your abdomen as on your chest.  If you don't want too long, this is correctable with a capsulorraphy.  If you wait too long (and more stretching occurs), you will likely need to add a lift.  Your scar can be cut out and made fresh at the time of surgery. Your incision will be located in the fold after the surgery.Good luck.

Curtis Wong, MD · Answer

You have some bottoming out from your photos and you should discuss options with your chosen surgeon as to how best manage this.  This could be a capsulorrhaphy where your implants are elevated on your chest and the pocket inferior closed up (but unpredictable and long recovery) or having a crescent of skin excised from the bottom (including your old scar) and the tissue plicated to shorting the length of your inferior pole which would eliminated the bottom heavy look and rotate your nipples down slightly.  Get the options and make the best choice for yourself.  Your plication could be done in the office under local if you are able to tolerate the injections you will need.

Stephen M. Herring, MD, DDS · Answer

There are three factors that make scars "unfavorable". One is contour. Another is width. Another is color. Your scars appear to be flat, so this is not a factor for you. Your scars are wide and pink. The color may improve further with time. The width will unlikely improve, with time and may become worse.With the size of your implants, and the position of the scars, I believe that it would be extremely difficult to improve these scars too any degree with a scar revision. If a revision is attempted, I believe it would be advisable to stent the repair for a long period of time to lessen the direct tension on the wound.There are many factors that determine final scar appearance. Some people have hereditary factors that predispose them to unfavorable scarring. From your images, this does not appear to be the issue in your circumstance. In other words, your scars may not the result of genetics. With a physical exam, the nature of your scars would be more accurately assessed, but it does not appear that you have hypertrophic scarring or keloid scarring. You do appear to have scar widening. This has been studied and the following conclusion was drawn. In new scars (immediately after surgery), tension placed on the scar is directly related to scar width (widening). In other words, if tension is placed on a fresh wound, that tension will cause the scar to widen. It appears that your scars are on your breasts, either from intentional placement, or from migration of the implant. In this circumstance, the tension or stretching force of the implant has caused the scars to widen. The same phenomenon can be observed in the abdomen. C section scars are generally hairline because they have very little tension (no tissue is removed), while tummy tuck scars are generally wider (tissue removed) which places more tension on the fresh wound.If you seek treatment, I suggest that you be very realistic about the final outcome, as this is a very challenging problem to treat.Disclaimer: The most accurate medical advice requires a complete history and physical with a personal consultation. This is rendered only as general information and is not medical advice. Medical advice can only be obtained by personal contact with a qualified professional. This response does not establish a physician patient relationship.

Andrew Elkwood, MD, FACS · Answer

Great question.  Unfortunately, I don't know any surgeons in your area but you would mostly do great with a scar revision.  You may even be able to do so just with local anesthesia so you don't have all the effects from general anesthesia.  Find a board certified surgeon in your area and get a consultation.  Good luck

Robert Whitfield, MD · Answer

Of course an examination is necessary but I perform scar revisions with the product Embrace.  It is an excellent product for scar revision.

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