7 weeks post and my periareolar scar spread. Using scar treatment gel and has faded a lot. Will it correct completely? (Photo)

A large part of the preop discussion with my patients is regarding the scar and what to expect. The lines heal well but take time up to one year to fully heal, scar cream is essential and massage all play a large role.

Best Scar Management is important to minimize or completely hide from view, the telltale signs of your surgery—namely, scars. Both you and your surgeon want you to have the most minimal scarring possible. There are many possible causes for scars that are enlarged or not healing well. Unsightly scars are most commonly due to genetics, underlying medical conditions, or improper scar/wound care. The last part is very important and patients can make a noticeable difference in their scars’ appearance by following best scar management practices. Here are some simple tips.
Scar Management tips:Minimize tension on the scar. Steri-Strips and/or surgical tape are often placed in non-hair bearing areas at the time of surgery 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”. In the first few weeks after surgery, I recommend the use of Embrace Scar Therapy which is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar.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”.Protect your scars from the sun. Staying out of the sun is the best advice. Minimal exposure to sunlight is prevents hyperpigmentation (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.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. The best product available in my opinion is the Embrace Scar Therapy System by Neodyne BioSciences, Inc. available in many surgeons’ offices. Essentially this is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar. For areas that are not applicable for this product (e.g. smaller areas or on the face), I prefer BioCorneum or Kelo-Cote products 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).. 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.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.

Dear newtojon,we specialize in minimal scars. It starts with a peri-areolar incision that hides the scar at the border of the areola. Next, I close my incisions in 5 layers and take stitches out week one and week two.  I don't recommend absorbable sutures because they cause inflammation that worsens scars. Then we tape your incisions once a week for 6 weeks. Lastly we start you on a 3 month topical scar management protocol with a scar gel thats FDA approved. It can take up to 12 months for a scar to fully mature, so there is still a chance that yours will improve. Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

In general, incisions stay red lumpy and bumpy for six weeks. Firmness and color of scars can take one to two years before you know the final result of healing. Best to keep your surgeon in the loop to effect the best possible outcome.
Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author

hello thank you for your question and provided information as well...My recommendation is to wait 3 months using treatment for scars, after that check with your plastic surgeon but improved to evaluate a possible revision of scar.

Thank you for your question. It will continue to get better. It may take up to 9-12 months to mature. Please follow instructions from your PS.

Thanks for the question.I see a few issues here:1. Your scar does not look like the incision was placed exactly at the areolar border - I see a bit of areolar pigmentation beyond the scar edge. While some surgeons may feel this allows the scar to "hide" inside the pigmentation, I think it accentuates the contrast because is results in a white scar (in caucasian patients) in between areas of darker areolar. I prefer to place the scar precisely at the border to let the scar be part of the demarcation between areola and breast skin.2. Your skin is highly sensitive but I disagree with one of my esteemed colleagues here (I usually agree 100% with his assessments so this is a matter of personal opinion) that absorbable sutures worsen scars. This partly depends on what exact technique of incision closure we are talking about. Generally these incisions are closed in multiple layers with absorbable sutures to seal the deep tissues over the implant, align the skin edges to reduce tension, tighten the areola if a lift is being done, and then a final layer of sutures is placed to tightly align the skin. This final layer is typically a "subcuticular" stitch of absorbable suture but some surgeons will use a nonabsorbable subcuticular stitch and take it out in 10-14 days. Others will close the skin with an external nonabsorbable suture, in which case early removal is necessary to minimize stitch marks. External absorbable sutures may indeed worsen inflammation in some patients so they often have a limited role.3. The widening of the scar is not uncommon after periareolar lift, but is uncommon if no lift was done. In any event, you may wish to consider, several months after you've fully healed up, revising the scar and the areolas to improve the overall areolar shape and scar appearance.

Scars take about a year to fully mature.  Make sure to avoid scar treatments until your incisions are completely closed unless your surgeon directs you differently.  Scar creams and silicone sheeting will take several weeks, even months before improvement is shown. I know it's hard, but try to be patient.

since the incision broke down there is scar tissue.  it may need to be revised but preferably not sooner than 6 months after the procedure so the scar tissue and surrounding fibrosis has softened enough so a better outcome can result from the scar revision.  it is usually a simple office minor procedure under local anesthesia involving excising the excess scar and 2 layer suture closure, absorbable sutures under the surface and removable sutures or sterristrips ( tape ) on the surface.