Is this a keloid scar or a hypertrophic scar? (Photos)

Question

Is this a keloid scar or a hypertrophic scar? I am 2 months post operative from breast reconstruction. I have had one round of steroid injections 4 days ago. My plastic surgeon says that they are keloid scars, but after looking at other's images, I am concerned that he is wrong. Also, I am in intense pain and have severe itching. I cannot wear a bra or have anyone touch the scars.

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Lewis Albert Andres, MD · Answer

Hello!  Thank you for the question. I agree that this is a hypertrophic scar. Such scars have an overgrowth if scar tissue but remain within the scar.  While keloids have overgrowth of the collagen scar that extends beyond the margins of the original incision. Perhaps scar massage and silicone and such might be helpful at this stage.  Steroids may be helpful at this time. Otherwise, consideration for scar revision may be entertained if still unsightly scarring.  Best wishes!

Michael Orseck, MD · Answer

Continue with the current management, steroid injection, silicone sheeting, aggressive scar massage.  You should see improvement over the next few months.  After a year, when all has softened, a scar revision may be necessary.

Chris Porter, MD · Answer

I agree with you that these are hypertrophic scars. Hypertrophic scars typically occur soon after surgery and are limited to the size of the initial scar. Keloid scars typically do not occur for a minimum of 18 months post surgery and will overgrow the initial scar size readily. Fortunately for you hypertrophic scars are far more responsive to conservative management. Continue with the steroid injections every 6 weeks for maybe three episodes. Also, perform scar massage on yourself and apply silicone sheeting. This combination should settle your symptoms and see the scars improve in appearance at 3-6 months. If they do not settle then you have the backup option of a surgical scar revision which you could consider at 12 months post surgery.

Kelly Killeen, MD, FACS · Answer

This is a hypertrophic scar.  The difference is that keloids grow out of the bounds of the original wound.  It is very common for hypertrophic scars to itch and be tender from the inflammation.  The steroid injections are helpful with both these symptoms and the appearance.  It frequently takes multiple injections to get the scarring under control.  After the scar is flat and healing more normally, there are various options to further improve it's look.  Make sure to discuss silicone sheeting and laser options with your surgeon.

Is this a keloid scar or a hypertrophic scar? (Photos)

Answers (5)

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