Breast lift scar revision! It has been almost a year since my surgery. (Photos)

Question

Some parts of the scars have faded nicely but there are some red and raised parts. My areolas are also a bit larger than i wanted, and not the same size...should I go for a scar revision, and would this include resizing of the nipple? Thanks!

Raffy Karamanoukian, MD, FACS · Answer

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars. 
 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Daniel Barrett, MD · Answer

Hi implanttoexplant,
  
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.
  
I understand you are concerned with the appearance of your scars. As your scars heal, it should flatten out and lighten. Loss of pigmentation may also be experienced but will resolve over time. Always follow your surgeon's post operative care instructions when it comes to scar management to avoid any complications like infection and for faster healing and recovery.
  
If you are concerned, you should visit your plastic surgeon for assessment and to discuss your concerns, as different surgeons have different approaches in scar management. Your surgeon can also advice you of new innovations that can help with managing and improving the appearance of scars like lasers and other scar treatment modalities.
  
Daniel Barrett, MD, MHA, MS
  
Certified, American Board of Plastic Surgery
  
Member, American Society of Plastic Surgery
  
Member, American Society of Aesthetic Plastic Surgery

S. Larry Schlesinger, MD, FACS · Answer

If you were my patient, rather than a scar revision which has multiple potential drawbacks, I would recommend lasering the hypertrophic scars to flatten them out, then tattooing to cover the scars.  This can also be used to decrease the difference in the diameter of the two areola.In my practice, we utilize an expert tattoo artist experienced in medical tattooing.  This process matches your areola color so that you can cover up scars.  Unfortunately, scar revisions may lead to more scars.  Since your wound healing process on both of your breasts led to the same scarring, possibly this type of scar formation may be part of your genetic makeup.I recommend you ask your plastic surgeon about why you got these scars and if a secondary scar revision might in fact lead to the same scarring process.

Stan M. Valnicek, MD · Answer

Thank you for your question.  At one year the scars are fairly stable and improvement beyond this point will be slow and possibly minimal.  It appears from your photos that portions of the scar have healed well while others are hypertrophic.  The fact that some portions have healed without hypertrophy suggests scar revision might certainly improve the situation.  Surgery is also the only way to reduce the areolar diameter.  
I would book an appointment with your surgeon to discuss the situation.  If you do have a revision of the scar, I would suggest silicone scar strips or gel to be used for 2-3 months afterwards (all these products available over-the-counter in most major pharmacies in the band aid section), as they help minimize recurrence of the hypertrophic scar.

R. Stewart Collins, MD · Answer

If nipple size is a big concern for you, then the only way to alter that would be with surgery. From your photos, it does look like you may have some hypertrophic scarring, which a revision could help with, but there are also options like laser treatments that can address scarring. I’d suggest consulting with the surgeon who did your aug to get their recommendations, and then to also seek the second opinion from an in-person consultation with another Board Certified Plastic Surgeon.

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