What is the Healing Process of an Areola Incision? (photo)

Question

I just had breast aug with an areola incision 3 weeks ago. I am putting bacitracin zinc on around 3 times a day. Then next week I am starting silicone strips for 12 hours a day. The scars look scary now, but i know they will look fine eventually. I was hoping you guys could tell me specifically about the healing process, how long it takes, what to expect. etc. and if you have any tips for the scars to look as good as possible. Thank you. p.s. when will the initial redness go away?

S. Larry Schlesinger, MD, FACS · Answer

WOW - what a great early appearance of a surgically well executed Benelli (circumareolar) mastopexy.  I agree with Dr. Tholen.  You need to stop the Bacitracin asap.  This will quickly lead to an allergic reaction.  I personally don't use silicone sheeting.  Since scars tend to separate leaving a visible scar between the areola and your breast skin, I use a particular type of steri strip called Proxistrip.  I place them around the areola and over the junction of the areola with the breast skin.  They are very long lasting and can stay on for two weeks without problems.  I change them every two weeks for about three months.  I find that this allows pleating to go down without separation of the areola from the breast skin.  With reference to the redness of your scars, the redness is there because there is increased blood supply where new collagen is being laid down.  This collagen gives strength to the healing tissue.  The redness will go once the scar matures, and scars mature faster in my experience with steri strips supporting the wound healing.  The strip itself teaches the new collagen to come in flat and not bumpy.  

	This, of course, is what I recommend in my practice.  Since your surgeon did such an excellent job of the surgery, I am sure he or she also has a post op regiment which will give you the best results based on his or her own surgical technique.

Tim Neavin, MD · Answer

Thank you for your question. Shortly after the wounds heal, you may be left with a red, raised line along the edges of the incision. Over time, the scar color should fade to pink and then to white. They should also flatten out in texture. This scar lightening will take several months up to a year after surgery.

David J. Levens, MD · Answer

Your early appearance looks perfect. Using a silicone gel and/or sheeting is the best treatment for your scars as you are doing and you should continue for at least several months. With time there will be lessening of the early redness. Also the early "puckering" appearance is quite normal for the type of "donut" lift that you had and it will lessen/flatten with time.

Young R. Cho, MD, PhD · Answer

Thank you for your question.  Breast incisions can be managed using a multimodal approach:
1)  Scar massage - starting as soon as the surgical dressings come off and the incisions are sealed
2)  Silicone sheets or scar gels for about six months to year
3)  Embrace - a tension reducing dressing for the first 2 months
4)  Fractionated lasers to help blend the scar into the background - done as a series, starting about 4 weeks after surgery and repeated every four weeks for six months.
5)  Sunscreen to prevent the scars from darkening

Richard J. Bruneteau, MD · Answer

Scarring is inevitable after any surgical procedure.  When breast augmentation is performed, every
effort is made to hide scars where they won’t be noticeable.  The peri-areolar approach hides scars at the
junction between the areola and the surrounding skin.

It’s
important to remember that wound healing continues for over a year after a
surgical procedure.  During this phase of
wound healing, there are several maneuvers that can be performed to minimize
scarring.  These include mechanical
massage, the use of Silastic sheeting and topical agents such as Mederma.  Even when these methods are used, scarring
may still be a problem.

If
scars have failed to improve after they have reached maturity, scar revision
may be an option.  If you’re concerned
about scarring, you should consult your plastic surgeon.  Your surgeon will be able to recommend an
appropriate course of action.

Richard H. Tholen, MD, FACS · Answer

First of all, you have a nice result, especially for a periareolar incision. You have no evident healing problems, and no open wound edges, so I'd stop the Bacitracin immediately, or else you risk causing an allergic or hypersensitivity reaction that "looks" like an infection. The usual response to this is MORE Bacitracin, so you can see how that vicious cycle gets rapidly out of hand! Your incisions are sealed, so there is no need for antibiotic ointment of any kind.

	Silicone scar sheeting is good, and most plastic surgeons agree on its effectiveness, even if we don't have double-blind scientific studies that have proven unequivocal benefits. Warmth, moisture, and contact inhibition can help to reduce the tendency for hypertrophic scars, but its benefit in patients with "normal" healing is questionable. If your skin gets irritated, then it should be discontinued or its use modified.

	Scar studies have shown that "average" healing takes 7 months, but of course, there are patients who are on both sides of the bell-shaped curve that is centered at 7 months. You should avoid ultraviolet exposure of any kind (including tanning beds) to prevent darkening of your scars. Mist or airbrush "tans" are OK. Then use the highest SPF if you must expose your breasts to ultraviolet on that nude beach.

	But mostly, you should follow your surgeon's advice, since it is he or she you will complain to if these don't turn out like you hope! Best wishes!

Michael M. Omidi, MD, FACS · Answer

Thank
you for the question. It looks like you have nice post operation results.  You are still in
the post operation recovery stage.  It is
not uncommon to feel pain, itchiness, and swelling during this
period.  It usually takes about 8-12
weeks for the wounds to heal and around 4-6 months for the implants to fully
settle. Your scars should fade over time.  Best of luck. Dr. Michael Omidi.

An
in-person exam with a board-certified plastic surgeon is the best way to assess
your needs and provide true medical advice.

Robert Stroup, Jr., MD, FACS · Answer

From the photo, it appears that you have had a well-executed combination breast augmentation / lift.  Several things have to occur for your healing to be complete.  Bruising and swelling have to resolve.  Scars have to fade.  The 'pleating" in the per-areolar area has to smooth out.  All of these things are on slightly differrent time-tables, and the process will vary somewhat from patient to patient.  But I will give you the general guidelines that I discuss with every patient.

	Bruising usually resolves within 10-21 days and is the first thing to get better.  Warm compresses or a heating pad after the first 2 or 3 days can speed this process up a little.

	Swelling usually starts to go away at the end of the first week and, initially, gets better very quickly.  Then it begins to taper off somewhat.  Very roughly - up to 75% of swelling will be gone by one month, about 90% by three months, and 100% after six months.

	Pleating around the areola can be pretty significant ("scary") at first and is dependent on how much loose skin is gathered in the lift.  Most patients have essentially flat scars after 3-4 months.  (See guidelines below regarding care.)

	Scars go through an initial 6-8 week period of thickening and scar tissue formation, followed by several months of scar fading.  During this second phase, scars get softer, flatter (see "pleating" above), and the redness goes away.  The length of the fading process varies a lot from one person to the next, and can take anywhere from 4 or 5 months up to 2 years.  Initially steri-strips or antibiotic ointment is all that is necessary.  Then, for those patients who want to be more pro-active, options include topical silicone gel, Vitamin E oil, and massage.  All of these things can speed up the process a LITTLE BIT.

	It looks as if you are off to a great start.  Stick with it, and keep up the good work.  The result will be worth it.

Tom J. Pousti, MD · Answer

Congratulations on having had the breast augmenatation/circumareolar  breast lift procedure; it seems like your plastic surgeon has done a nice job for you and that you are healing nicely.

	Time  It is the most important factor when it comes to improvement of the appearance of scars. You will find that the scars will improve in appearance  on a monthly basis and even after a year has gone by.

	I would suggest that you run your question by your plastic surgeon;  asked about the use of silicone-based products such as gels or sheeting.

	Best wishes.

David E. Berman, MD (retired) · Answer

you don't need to use bacitracin after only about 5 days after your breast surgery. my office uses a silicone gel but other places will use silicone sheeting. The vast majority of these scars do great regardless, - it just takes time. sometimes these scars fade a lot within several months and for other women, it can take a year or more. They will keep improving with every passing month for the rest of your life.david berman md

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