What's the best way to resolve "significant tethering" of scar? (Photo)

The underlying scar tissue of your left nipple needs to be released. A device called a pickle fork can be used to release the scar. A technique called  Rigottomy, can also be used to release the scar tissue. After the scar release, you will need to have fat grafting so the scar will not stick back down. You may need several treatments.Yours,Jon M. Grazer, MD, MPH, FACSPlastic Surgery,Newport Beach, CA

Dear jlb415Most of the time, when performing an areolar incision for breast augmentation, we dont take the direct/straight dissection to the chest wall. We follow the curve of the breast across the inferior pole, and then create a pocket, above or below the pectoralis muscle and place the breast implant. This forms a stair-step of soft tissue between the scar at the areola and the formed scar through the incision and at the pectoralis muscle. You have not stated how long its been since your surgery but guessing from the appearance of your right breast, more than a few months. The first steps are massage and possible injections of kenalog into the scar. Surgical approach in next. One of the best ways to manage its impact is to surgically release the scar and then use your breast tissue to interpose, so a straight scar does not reform. You can also use other materials for interposition. You could consider doing this and repositioning your implants to a pre-pectoral plane (or using a dual plane lift) to enhance your nipple areolar position. A breast lift is another option. I suggest a consultation with a surgeon Board certified by the AMerican Board of PLastic surgery.

Sometimes a tethered scar can occur after an infection, however, they can occur with any surgery.  The tissue layers may be misaligned or there may have been some bruising or bleeding associated with the scar.The most efficient way to correct this is to release the scar with a needle and inject fat grafts beneath the scar.  This can often be performed in an office setting under local anesthesia.

From your photos and history, I believe you may have had breast implants placed below the pectoralis muscle.  Although this is perfectly appropriate to do, one can sometimes develop a scar or capsular contracture which can be accentuated with the flexing of the muscle.  If this is the case, the problem can be corrected with a surgery to release (capsulotomy) or remove (capsulectomy) the scar.  This could be done on an outpatient basis and the surgery would take approximately an hour to perform. Best wishes, Dr. Lepore.

I see your problem and understand your concern. I wish I knew how far out you are from your surgery, and also wonder if you have returned to your surgeon. If this is rather new, you may have improvement with massage. Otherwise this will likely require surgical release followed by vigorous massage and moisturizers.Good luck!