How to Treat Keloid or Hypertrophic Scarring in Incision Scars

I had a breast implant removal about 3 months ago.Since then my infra mammary scars have become slightly raised, hard and adhered to the underlying tissues but limited to the scar boundaries. My PS advised me to massage them daily 2-3 times a day which I have been doing for the past month.It seems to have improved however I have noticed a very small nodule that has developed within one of the scars (very small only 0.5mm).Do I need any further treatment and will this worsten or resolve w time?

Doctor Answers 13

Hypertrophic incision scar

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Typically scars improve with time, and take about a year to get to their final situation.  They typically look their "angriest" between 1 and 4 months.

Scar massage helps.  Silicone scar products help.  Sometimes a little Kenalog injection is useful.  Sometimes IPL is helpful if the scar is very red in color.

Speak with your surgeon about your concerns.  

Treating Keloid or Hypertrophic Scarring in Incision Scars

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Scars normally are the worst around 2-3 months, because the collagen that has been laid down in the wound hasn't had a chance to mature and soften yet.  This is part of the normal wound healing/scar formation process.  However, if the scar is unusually thick or red, it is possible that you are getting a hypertrophic scar.  By the way, people often refer to these as keloids, which is not usually the case.  Keloids are similar, but continue to grow beyond the wound, and are rare.  If you are developing a hypertrophic scar (or even an unlikely keloid), your surgeon might inject some steroid into it.  Most early hypertrophic scarring can be controlled this way.  Other methods can also help early on, like silicone gel sheeting, or even lasering.  Sometimes these methods help flatten the scar and improve its color, but won't make it narrower if it is wide.  In that case, you likely will need a scar revision.  It's probably to premature to determine that though - just make sure you have regular follow-ups with your plastic surgeon and follow his or her advice regarding the scar care.

Scars Continue To Heal For 12-18 Months

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Unfortunately, scarring is a part of any surgical procedure.Whenever possible, plastic surgeons place scars where they are well hidden by anatomic structures.When breast augmentation is performed, every effort is made to hide the incision.For this reason, they’re often placed in the armpit, at the border of the areola with surrounding structures, or in the inframammary fold region.

It’s normal for scars to be red, raised, hard, and bumpy three months following surgery. Over the course of time, this should improve significantly. Scars generally take about 12 to 18 months to reach maximum improvement. In six months, the redness should be significantly improved.

In the meantime, this keloid can be treated with massage and the use of topical agents.In some cases, silastic sheeting can be used and rarely, steroid injections may be helpful as well.If scarring fails to improve with these steps, a scar revision or skin resurfacing procedure may be necessary.

It’s important to maintain good communication with your plastic surgeon.It’s still very early in the post-operative period and significant improvement will probably occur.Be patient,you may ultimately be very happy with your result.

Scar Management after Breast Implant Removal?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Time tends to improve the appearance of scars. You will find that the scars will improve in appearance even after a year has gone by.
 
Sometimes the use of silicone-based products. In the event of unfavorable scarring steroid injection may be helpful. The use of superficial radiation treatment is possible for symptomatic scars.  Sometimes scar revision surgery and careful scar management afterwards may be helpful. Despite anecdotal reports I have not seen significant improvement with laser treatment of scars.

Best wishes.

Keloid at the incision site from breast surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You may want to consider the injection of steroids into the incisions to help with healing.  Pressure and massage are also very good.

Thick scar after breast implant removal

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Scar is very individual, and usu sally the inframammary scar will do very well. At three months I would avoid over treating the area, and steroid may be overkill. Stick with massage. Your bra will apply pressure over the area which helps as well, and time should solve all.

Best of luck,

petrejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Scar

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I treat my scars with silicone and steroids but a half mm scar is likely a knot.  Keep massaging it as you have been and it will likely go away.

Ricardo A. Meade, MD
Dallas Plastic Surgeon
4.9 out of 5 stars 125 reviews

Scars and breast surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It sounds like you have hypertrophic breast scars and from your description is improving. As for t he one area of concern I would run it by your surgeon after he/she sees it.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Thick Scars After Breast Surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Scars take upwards of one year to reach their final state. At 3 months, your scars are in the relative early phase and typically go through changes in their thickness as well as color. Your plastic surgeon was correct in advising scar massage which takes advantage of one of the main modalities in scar treatment: namely pressure therapy. Other things that may help are silicone based scar treatments which come in adhesive sheets or creams.

Other than that, I would not recommend any further treatment at this moment as the scar will settle with time.

Hope that helps and good luck!

Babak Dadvand, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 51 reviews

The treatment for recent scars

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

is to do nothing for about 9 months.  The reason is that it takes this long for scars to mature.  After nine months, scars will soften and flaten.  If your scar remains or progresses in an unacceptable manner, an injection of triamcinalone 40 mgm/1 cc should be considered.  See your local plastic surgeon and discuss this with him.

Gary H. Manchester, MD (retired)
San Diego Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.