What Are the Best Treatments for Keloid Scars After Breast Reduction?

I had a breast reduction about 2.5 years ago, when I was 17 years old. I unfortunately developed keloid scarring. I was wondering what the best way is to go about treating them. I've had some laser treatments and that definitely helped but they were very painful. I am considering kenalog injections and then possibly, when they have flattened, some cosmetic tattooing. Are these good ideas?

Doctor Answers 9

Breast Keloid/Hypertrophic Scar Management

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First of all the ropy scars you have from a technical standpoint are called hypertrophic scars not keloids. Most important they can be improved. Most important is to see a board certified plastic surgeon.
Here are some guidelines to obtain the best scar improvement:

Scar Management tips:
  1. Minimize tension on the scar. Embrace scar dressing is the best as it lessens tension directly on the wound. Steri-Strips and/or surgical tape are often placed in non-hair bearing areas to minimize tension and keep pressure over the scar. This minimizes the stress that can pull the scar apart (dehiscence) creating a wound and delaying healing time, and can make the scar wider, or more “ropy”.
  2. Keep your incision site/scar clean to prevent infection. Follow your surgeon’s wound care instructions to the letter with out modification. Never apply different products then recommended without first discussing them with your surgeon. This is especially important during the first few weeks. If there are any signs of infection, contact your surgeon’s office right away and/or see your doctor or his nurse immediately. Typical signs of infection may include redness outside the immediate incision site, asymmetric swelling, and drainage, of pus, fever, chills, and “feeling sick”.
  3. Protect your scars from the sun. Staying out of the sun is the best advice. Minimal exposure to sunlight is preventshyperpigmentation (permanently turning brown) and other problems that can make the scar more noticeable. Sunscreen, at least 30 SPF and an overlying make camouflage make up additionally protects the scar from the suns harmful rays. This advice is especially important the first year following your surgery.
  4. Use specific scar maturation products recommended by your surgeon. Patients seem to have their own opinions on this touting everything from Pure Vit E, Coco butter, to Aloe Vera, etc but most have minimal benefit other than keeping the scar hydrated. Although hydration is important there are better, scientifically studied products with greater efficacy. Most of the scientific articles written about this subject indicate that topical silicone gel or silicone sheets work the best. There are a lot of products to choose from, but silicone should be one of the key ingredients. Although Mederma, an onion extract derivative active ingredient rather than mainly silicone based may help, primarily silicone based products are better and many also contain other ingredients that may be synergistic (hydrocortisone or other steroid, Vitamin E, Sunscreen,etc). At the present time I prefer BioCorneum or Kelo-Cote products especially on areas that silicone strips aren’t applicable, for example, on the face. If the reader has problems obtaining these they can call my office. Patient compliance is also critical – use often and according to directions or it will not work optimally. NEVER apply products without first discussing them with your surgeon.
  5. Monitor to make sure your scar is progressing optimally. Keep your scheduled follow-up appointments with your surgeon to verify that your scars are maturing as expected. Occasionally if indicated you may need a topical steroid preparation or even a series of injections (5-FU and/or Steroids) or laser treatments to treat or prevent scar hypertrophy or keloid formation (red raised scars), or other topical medicines to treat post inflammatory hyperpigmentation (brown scars) with prescription creams and possible laser treatments.

Scar Removal

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Silicone tape, steroids injections, then scar revision.  See a Board Certified Plastic Surgeon for this. Thank you for your question and good luck with everything.

Hypertrophic scars following breast reduction in a 17 year old

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As you have read from the other plastic surgeon respondents, the scars that you have are hypertrophic ones rather than keloids. This is relatively good news as hypertrophic scars are more easily treated as compared to keloids which can be quite difficult to eradicate.

At your age, hypertrophic scars are not uncommon with breast reduction surgery. Given you photos and history, my recommendation would be to surgically remove the thicker and wider areas, meticulously repair the wounds with longer acting dissolvable sutures, inject them with a very low dose steroid, protect them for a few weeks with surgical tapes and them start with silicone gel sheeting for at least several months. Certain physical activities that could exert distracting forces on the wounds (pulling apart) should be avoided.

Hypertrophic Scars Following Breast Reduction

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You have hypertrophic breast scars, not keloid scars. These do seem to occur more commonly in younger patients, and the alignment of the skin edges, wound tension, and suture material used may also play a role. It appears that some areas have improved after your laser treatments and are now flatter, but remain widened. Additional laser treatments and steroid injections may help to soften and flatten the residual areas of hypertrophy. You will be left with wide scars following these procedures, and they may have a pink coloration. Sometimes additional IPL or laser treatments can lighten this pink color.

If your goal is to try to remove as much of this scarring as possible then you will need to consider surgical scar excision. The subsequent healing may be improved since this revision will likely involve less tension across the skin closure, and care can be taken to realign the skin edges well. Post-op taping and silicone gel sheeting may provide some additional benefits. When it comes to scar revisions, there are no guarantees that unsatisfactory scarring won’t occur, but I suspect that you will have a better result.

I would not recommend cosmetic tattooing of these scars. The thin scars may not take the pigment well, and more importantly it is impossible to match the skin coloration well with tattoo pigments. Skin coloration constantly changes and there is not a good way to match this with (even multiple) tattoo pigments that will always be the same color.

Best wishes, Kenneth Dembny MD

Breast reduction scars and improving scars on the breast

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I would begin treatment for your breast scar keloids with pulsed dye laser and judicious IIT therapy.  These scars will improve.

Hypertrophic breast reduction scars

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Your scars, thankfully, are hypertrophic and not keloidal. They can be treated first by silicone sheeting or, if unsuccessful, by kenalog injection. If both these conservative methods do not alleviate the scarring, the scars could be excised and the area resutured in a scar revision procedure. I recommend excising a small area and then observing for improvement. If successful, you can continue with outpatient excision with meticulous closure. By closing breast reductions using careful suture closure initially, I try to reduce this complication in my patients.

Options for hypertrophic scars after breast reduction

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Hopefully better options will be available in the future, but you have had the standard treatments with laser and steroid injection. Check out clinicaltrials.gov and search hypertrphic breast scars.

Best Treatments for Keloid Ssars After Breast Reduction?

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Good News and Bad News.

You do NOT have Keloid scar (raised scars which overflow the margins of the original injury or surgical incision). These are MUCH harder to treat successfully. 

Instead, you have a mix of widened (? result of Kenalog shots) and Hypertrophic (exaggerated, speed bump like) scars. Many of these can be made to look better by surgical excision, revision and meticulous closure with dissolving stitches in multiple layers minimizing tension at the skin surface. Additional treatment with scar modification (Silicone sheeting, Mederma, Vit E ) may also help the final appearance.

Good Luck.

Dr. Peter A Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon

Keloid and Hypertrophic Scar treatment

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Your scars are more accurately termed hypertrophic scars rather than keloids, although I doubt that distinction brings you any comfort!  Many young breast reduction patients develop scars such as these.  If you did not use silicone dressings during the healing process, you could consider excising the scar in the inframammary fold and keeping silicone on it during the healing process.  If that worked well, you could try the same on the rest of your incisions.  Steroid or fluorouracil injections could be tested in bad areas, and if they work well you could try similarly treating the rest of your scars 

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.