Do I need a scar revision after an areola incision breast augmentation? (photo)

Question

I am 3,5 months post op and quite happy with my results. But there's this discoloured scar on the areola of my left breast (there is a less noticeable one on the right,too). I use a silicon gel, following my doctor's advice. He recommends a very quick scar revision with local anesthetic 5-6 months post op. Do you agree? He also recommended sun exposure for 10-15 minutes everyday to make the scar darker and blend in. But I read that sun exposure is bad for scars. What is your opinion? Thank you!

Thomas A. Mustoe, MD, FACS · Answer

I would agree that your scars are much more visible than ideal and could be definitely improved from scar revision.  It is not clear what happened during the original surgery, but scar revisions can easily be done in the office.   Although we have published research that  ultraviolet exposure (sun) does not make scars larger, it can increase pigment.  In your case, I doubt sun exposure is going to help much.

Rukmini S. Rednam, MD, FACS · Answer

Hello,While things are healing it can be so hard to be patient but it can take up to year for scars to heal well and fade.  That being said when scars do not look like they are healing as well as desired ,6 months is usually the earliest most plastic surgeons will consider doing revisions. It sounds like your plastic surgeon has been very on top of addressing this issue so I would continue to follow his recommendations.  In general I do recommend sun protection during active healing but each plastic surgeon has reasons for their individual recommendations. Best of Luck with your healing!Dr. Rednam

Gerald Minniti, MD, FACS · Answer

Hello,I'm sorry to hear you had breast augmentation via a periareolar scar. This puts you at highest risk for complications associated with bacteria and with other scar related shape issues. Judging from your pictures, there was quite a bit of trauma in the region, given the wide, hypopigmented areas and pit like depression. Despite these abnormalities, I'd be in no rush to have any revision surgery now, and would heal for at least another 6 months.  Also, I'd also go visit a few ABPS certified/ASAPS member surgeons who specialize in revision surgery.  Best of luck.

Jed H. Horowitz, MD, FACS · Answer

hello e_m All surgery leaves scars, some more visible than others. Although good wound healing after a surgical procedure is expected, this surgery will result in long, prominent scars that are permanent. Abnormal scars may occur within the skin and deeper tissues. Scars may be unattractive and of a different color than the surrounding skin tone. Scar appearance may also vary within the same scar. Scars may be asymmetrical (appear different on the right and left sides of the body). There is the possibility of visible marks in the skin from sutures. These scars may become raised, red, or discolored in the first few weeks/months, but usually settle down over time. However, some patients are prone to “hypertrophic” or “keloid” scars i.e., prominent, raised, red scars that do not settle. Further treatments with medications and/or surgery may be required. #scars #post-op

Daniel Barrett, MD · Answer

Dear E_M,for scars, I close all of my incisions in 5 layers and do not use absorbable sutures because they cause inflammation and worse scarring. I tape all of my incisions in the office visits once a week for six weeks after surgery to improve the appearance. After taping, I start my patients on a scar gel therapy for 3 months that they have to put on their incisions twice daily.You should discuss your concerns with your plastic surgeon as different surgeons have different approaches in scar management.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Jeffrey W. Hall, MD · Answer

Looking at your photos it looks like you had some skin loss at the wound edges which created the wide pink scar to form. I would predict that it leave you with an area the will not blend in very well and the only way to improve it is a scar revision or tattooing of pigment to the area. Most surgeons recommend revising a scar when it has had a chance to mature some between 2-6months after surgery. The longer you wait the better the results. Consult with your surgeon and they can direct you on your situation. Good Luck.

Ken Dolynchuk, MD · Answer

Thanks for the photos and your questions. A depressed scar which is also lighter and stretched is difficult to simply revise. Take time to consider the answers given already and be prepared for two or three procedures including fat grafting as well as laser treatments to improve your scars ultimately. Hope this helps.

Steven M. Camp, MD · Answer

Follow up with your plastic surgeon.  It sounds like you are getting attentive care and service.  In general, I recommend sun protection for optimal incision healing and I would discuss this with your original surgeon.Best Wishes

Ronald V. DeMars, MD (Retired) · Answer

From the photo it looks like something unusual must have happened as this skin generally heals with an invisible or nearly invisible scar. Taking out the current scar (which should not be done prior to 6 months postop, will likely leave you with a very irregularly shaped areola. Exposure to UV rays will probably not work because most scars of that character do not react to the sun. Have you considered medical tattooing to place areola colored pigment into the scar? This usually requires 2 or more treatments but is an easy fix.

Jon A. Perlman, MD (retired) · Answer

It's rare for the periareolar incision to heal with any visibility in my experience but waiting at least six months for evaluation would be my recommendation.  If there is depression you may need to consider fat grafting or if they are simply prominence of the scar revision maybe helpful.  At that point in time if you have doubts seek a second opinion.  Best wishes,Jon A Perlman M.D., FACSDiplomate, American Board of Plastic SurgeryMember, American Society for Aesthetic Plastic Surgery (ASAPS)ABC-TV Extreme Makeover SurgeonBeverly Hills, CaliforniaIG: jonperlmanmd

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