Curious about other surgeons scar control protocol. When do you have your patients start silicone sheets after a breast lift?

Question

My new surgeon does tegaderm for 3 months then switches to silicone of my choice. I purchased embrace for my lollipop incision. This is a breast lift revision. My precious lift is atrocious and I was left with wide scars due to tension (I was told this by multiple consults I went on) Curious as to what other surgeons scar control protocol is, when do you have your patients start silicone sheets?

Gerald Minniti, MD, FACS · Answer

If you can return that expensive Embrace, do it. Silicone is not essential in the first 8 to 10 weeks and may not be necessary at all. What's most important to scar formation is minimization of skin surface tension, and that is best controlled by an elastic and porous tape that can RELIABLY stay put for a week or more before needing a change. My go to tape is Hypafix (reference number 71443-01). Get two ten yard rolls for $18 on the internet.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding scar protocol. Every plastic surgeon has a different scar protocol, and every patient is slightly different in wound healing. However, once the incision is completely healed and there is no drainage, it is appropriate to start silicone treatment. My protocol usually involves silicone cream and gel 4-6 weeks after surgery. I typically try to continue this protocol for at least one year. If there are areas of hypertrophic scar, they may require microneedling, steroid injection of 5fu, Fraxel laser v-beam laser, and possible surgical excision. These are my silicone treatments, but every plastic surgeon has their variation on this theme. Silicone has been medically shown far superior to any other products like bio-oils or vitamin e. 
If you have any more questions regarding the breast lift or mastopexy, capsular contracture, or breast implants in general, please contact my office.  Since your breast surgery is somewhat complex for an average plastic surgeon, please seek an experienced, board certified plastic surgeon with significant experience performing these types of breast lifts. Do your research.  Make sure your chosen plastic surgeon has performed at least 100 breast lifts.  Make sure they have the before and after pictures to prove it.  Carefully examine their before and after pictures and check their reviews on RealSelf.  Good luck! Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, President of  the American Society of Bariatric Plastic Surgeons, Certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery,  and ​member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

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

Stanley Okoro, MD · Answer

Thanks for your question. Working with majority patients of color, this is paramount in my practice. Scar management at our office starts in the OR. With our suture technique and type of suture. We place tape on our incisions which stays in place for 1 month. After 1 month we recommend firm scar massage with Biocorneum silicone scar cream 2x daily. Finally, we recommend Morpheus 8 -/+ lumecca 3 months post op to assist with scar appearance. Good luck!

Daniel Barrett, MD · Answer

Dear Ddrr123,
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.You should discuss your concerns with your plastic surgeon as different surgeons have different approaches in scar management.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Justin K. Williams, MD · Answer

The most common reasons for widening of scars or placing incisions under too much tension, improper suturing, and poor wound healing capabilities of patient (poor nutrition, smoking, etc). Follow of these things have been managed, scar care is variable. Silicone gel taping silicone gel have been proven to aid in scar management. If your surgeon is confident in their technique I am sure works fine. My technique is to use Steri-Strips on the incisions for 4 weeks ( replaced after 2 weeks) and then to switch to a silicone gel or tape

Connie Hiers, MD, FACS · Answer

I tape my scars for 4 weeks, and then instruct patients to use scar products. Some do use silicone tapes and some use other products.

Williams Bukret, MD · Answer

In general, I indicate scar silicone sheets after the wound's healing is completed, on average a month after surgery. It could, of course, vary according to the patient's condition, and in some cases is not needed at all. Also, monthly control for at least 3 months is very important for early scar treatment.

Douglas McGeorge, FRCS(Plast) · Answer

The only treatment for scars, with credible science to back it up, is Solution for Scars, from a UK firm, Science of Skin.  
Importantly, further significant scar improvement is achieved by using the cream for 7 days in advance of surgery.
It is available on Amazon.

Jeffrey C. Hamm, MD - Account Suspended · Answer

A hypertrophic scar represents an abnormal response to tissue injury, resulting in deposition of excess collagen. Its prevalence is increased after infection or in wounds under mechanical stress. The scar doesn't grow beyond the boundaries of the original skin injury. 
A keloid is a genetic inherited disease in which scars progressively thicken beyond the boundaries of the original skin injury.

Attempts at prevention include external incisional support with application of tape and application of pressure and immobilization of the healing scar with application of silicone gel sheeting. In our practice, we start silicone gel sheeting once all incisions are sealed and appear to be healing satisfactorily.

There are non-invasive and invasive methods to treat thick scarring. Hypertrophic scars often spontaneously regress with time, the final scar noted when the redness of inflammation has subsided (usually at 12-18 months). Keloids may become inactive but usually do not regress.
The application of pressure and immobilization of a scar with silicone gel sheeting appears to hasten resolution of the process. Various creams are available, but their efficacy is questionable.
Laser treatments are available with varying degrees of success. 
Injection of corticosteroids directly into the scar may flatten the scar and alleviate symptoms, but may also broaden the scar and cause pigmentary change in the skin locally. For this reason, we usually delay its use for as long as possible.
Surgical scar revision is an option to consider if regression is not noted at 12 months after the procedure. This is often successful in treating hypertrophic scars, but, on the other hand, keloid recurrence is quite common. 
Speak about your treatment options with your plastic surgeon.

Curious about other surgeons scar control protocol. When do you have your patients start silicone sheets after a breast lift?

Answers (10)

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