What causes scars to widen after surgery? Going for a revision surgery.

Question

What are the reasons scars stretch or widen after surgery (specifically breast lift) 1. Surgical technique? 2. Pressure/tension from the lift? 3. Improper scar maintenance? Those are the most common answers I've seen but what causes the widening and how do I avoid it from happening again during a second revision surgery?

Gerald Minniti, MD, FACS · Answer

That's why it's important for surgeons to use sutures that tighten deep fascia to support wound closure, use carefully placed finishing sutures, and tape using elastic and porous tape for months after surgery. Tension reduction, precise epidermal closure leading to rapid epithelialization, and mechanical support of the suture line all play a part in fine scaring.

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

Gary M. Horndeski, MD · Answer

If you have a vertical scar technique for your breast lift then the mechanical load on the vertical scar is widening. For that reason, there are two techniques that avoid the vertical scar: The Bellesoma Method or the mini lift. However, if you already have these scars present then there is not much you can do about it.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Mark Baldwin, MBBS · Answer

The answer is of course "all of the above"...but the biggest factor, that you haven't mentioned, is genetics. In general the patients needing a breast lift don't have great skin elasticity, and are prone to getting stretch marks and developing widened scars. The 2 biggest 'red flags' for scar stretch in my experience, are previous scars stretching, and natural stretch marks. If it's your second revision, (as opposed to first revision) then I doubt you can full prevent it.

Finny George, MD · Answer

Hi, thank you for sharing your question. Wide wing of scars are typically due to three main causes: too much tension on the closure, surgical technique and dermal skin quality. The latter is out of your control and if it was the primary reason, you may develop widening again.

Ronald J. Edelson, MD · Answer

There are many factors that affect how scars heal. A lot of it is individual variation in addition to technique

Daniel Barrett, MD · Answer

Dear Ddrr123,
we specialize in minimal scars. Its 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. 
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Michael Ablavsky, MD · Answer

Scars can widen for a number of reasons one of which is the dermis layer (strength layer of the skin) begins to gap. This can happy because the dermis is thin (poor skin quality), location of your scar (particular area of breast or elsewhere), technique, or tension amongst other things. Some factors you can control to optimize scar management include post operative relief of tension (compression wrapping may help), sun protection/avoidance, scar massage, possible silicone gel/silicone sheets for raised scars. Best to discuss specifics of your situation with your surgeon.

Connie Hiers, MD, FACS · Answer

Usually there is less swelling and tension on the scars with scar revision, so widening is less of a problem.  I would still use scar products or tapes as soon as the surgical tapes are removed.  A good supporting bra will also be helpful.

Camille Cash, MD · Answer

All of the things you mentioned can influence how your scars heal after surgery.  You want to be sure first that you select a board certified plastic surgeon for your procedure.  You want to ensure that the proper lift is done.  Some patients try to "get by" with a more minimal lift to avoid scars, but end up with poorly healed scars because the lift performed was not adequate for the patient.  After your procedure closely follow your surgeon's instructions.  Begin scar therapy as soon as it's deemed safe to do so and make sure you are consistent with it.