How can I detach what I believe is a tethered scar that occurred after periareolar incision? (Photo)

Question

I had a breast augmentation several years ago. I think I have a tethered scar on the left breast. Implant is silicone, subpectoral. As you can see, the scar is quite heavily indented. This is very unpleasant for me. I have gained a lot of weight since I had the surgery. Not sure if that is important here. Finally, I am quite broke, so lowest cost options are preferred. Thank you.

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

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The best advice you can receive is from an in-person consultation.  Based on your photograph, you may benefit from a surgical scar revision of your tethered breast incision.  This decision should be based on a detailed discussion with equal input from both you and your surgeon.   Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.   
 
 Best wishes and good luck.

Richard G. Reish, M.D.  FACS

Harvard-trained plastic surgeon

Ben Brown, MD (license emergency restriction) · Answer

Hello indentedleftbreastscar,
Thank you for sharing your experience. I'm sorry to hear and see that your result has not been as you likely imagined.
Your scar tethering is, as you know, quite significant. Given the location and the fact that you had a subpectoral augmentation, it is possible that the scar is tethered to the pectoralis major muscle, though it is also possible that it is limited to the subcutaneous space. 
In either scenario, your plastic surgeon will likely have to reopen the previous incision to disrupt or excise scar tissue until normal tissue is reached. If there is a significant quantity of breast tissue and scar that must be removed to improve the tethering - enough to result in a dent - then the surgeon may need to rearrange some of the breast tissue in the area to fill the hollow area. 
Unfortunately, it is possible that the depth of the scar is such that your surgeon will prefer to revise it in the operating room, since you do have a prosthetic device somewhere beneath the scar. If the scar reaches the implant capsule, there is always the risk of exposing the prosthetic device to the open air - if this occurs it is best that it occurs in the most sterile environment possible. However, this is impossible to fully assess without an in-person physical exam, and I recommend you return to your plastic surgeon to obtain a definitive diagnosis and plan.

How can I detach what I believe is a tethered scar that occurred after periareolar incision? (Photo)

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How can I detach what I believe is a tethered scar that occurred after periareolar incision? (Photo)

Answers (3)

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Everything you need to know about Scar Removal

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