Separation Scar and Fat Necrosis in Breast

I had a tummy tuck and breast augmentation in February and the nipple separated from the breast somewhat. There is a wide scar and I have fat necrosis, which seems to be getting somewhat smaller with massage. Do you recommend any specific treatment that I can do myself for caring for the scar and the fat necrosis in the breast? How long does this normally take to resolve?

Doctor Answers 2

Scar Removal

See a Board Certified Plastic Surgeon for advice on how to optimize healing, protection of the implant, and correct medication therapy if indicated.

Danville Plastic Surgeon
4.9 out of 5 stars 26 reviews

Scarring and fat necrosis after breast surgery.

You didn't say if you had breast lift surgery in addition to augmentation, as fat necrosis with breast augmentation alone is very unusual. Circulation impairment to skin flaps in breast lift surgery can cause fat necrosis (tissue death), and healing occurs around the dead tissue until  all that is left of the area that did not survive is scar tissue. Fat has poorer circulation than skin, so fat necrosis is not uncommon, but large areas of fat necrosis are both unusual and cause problems requiring more surgery. It sounds as if things have healed, and the wide scar and area of firmness beneath the skin is what you are dealing with now.

Time is the biggest factor here, as scar tissue softens and becomes less palpable, as you are describing. Gentle massage can help stimulate the body softening and maturing the scar tissue left in the area of fat necrosis. Your surgeon may also suggest steroid injection(s) to further flatten and soften scar tissue. Surgical excision of the wide scar can also be done when the tissues have softened enough to do this safely. In rare cases, the fat necrosis can be surgically excised, but this leaves a cavity or defect that must be later fat grafted. Of course, this can lead to more scar tissue and/or fat necrosis, so this should be undertaken only by someone who is experienced in fat grafting and feels that your unique situation warrants this recommendation.

Talk to your surgeon. Nothing should be considered until at least 6 months have passed, and 12 months would be better! Best wishes!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

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