Many studies have confirmed that many (most?) topical products for scar improvement are essentially worthless. Silicone scar sheets have been shown to reduce hypertrophic scarring in susceptible individuals, but may not have much benefit in the majority of patients who otherwise heal "normally."Certain topical pharmaceuticals in weaker formulations, as well as non-pharmaceuticals such as Vitamin E oil, various bio-oils, tea tree oils, etc. show nice before and after photographs, but the hard science is lacking as far as statistically-significant scar-reducing benefits (or we would all be using them).Though I cannot show hard science in my own regimen, I recommend use of topical scar recovery gel twice daily starting one week post-op, Vitamin E oil massage of the scars starting at 3 weeks post-op, and silicone scar sheets or pads at 4 weeks if there seems to be any sign of hypertrophy. Skin irritation and inflammation increases scarring, so scar pads have to be used carefully and judiciously to avoid irritation. Ultraviolet (sun or tanning beds [BAD]) should be avoided for 6-12 months or until scars have faded completely. No magic here, and probably just my own personal "garlic necklace" to ward off bad scars, but it seems to work for my patients most of the time. And yes, I still have a few bad scars no matter how accurately I close the incisions, or how tiny the sutures, or how delicate the tissue handling!Your breasts look as if you have residual areolar pigment in the vertical limbs of your inverted-T scar beneath your new smaller areolas, so if that is the case, this will not fade regardless of what you do. The rest of your scars look pretty good, and time, more than anything else, will give you the best result, such as my patient in the web reference below, whose scars in the after photo are at 7 weeks post-op. Best wishes! Dr. Tholen
