Correction of Scarring Associated with Primary Breast Augmentation/Breast Lift/Breast Reduction
It's not uncommon that scarring can occur that is significant from breast lifts and breast reductions associated with primary breast augmentation procedures. In fact, placing an implant concurrently with a mastopexy may increase widespread scarring, keloiding or hypertrophic scarring. In certain patients staging the operation, in other words, placing the implants subpectorally first waiting several months, then doing the breast lift may reduce scarring because it allows the stress and tension from the implant placement to be dissipated and greatly reduced prior to doing the mastopexy with the tension-free closure. This is a judgment call associated with the experience and judgment of the specific Board Certified Plastic Surgeon. Some patients will do well with combined augmentation mammoplasty with a formal mastopexy that is the Wise-pattern or anchor scar performed at the same time. Examples of these candidates include women with small amounts of breast tissue and severe grade III ptosis where the implant is absolutely necessary to regain volume and the skin should be removed concurrently in order to tighten up the brassiere at the same time. Women with very thick breast tissue and very large breasts who undergo lifts, may do better placing the implant six months to a year after the mastopexy is healed and the scars are given time to mature.
Revision on breast lifts and breast reduction scars can be done through many approaches. Nonsurgical approaches include silicone gel pray and sheeting, including Kelo-cote, Mederma, Scar Guard, collagen creams, Cortisol cream or Kenalog creams (steroid creams) and laser therapy. Surgical treatments can include after complete maturation, 8 months to one year, scars can be revised surgically by excising the scar, as long as it's not a keloid, but rather a hypertrophic scar, and reapproximating without tension the edges with fine suturing in a subcuticular fashion.
In our practice all breast lift/breast reduction patients, once sutures are removed, undergo some form of scar cream, whether it be vitamin E, Mederma, or Kelo-cote in order to reduce the scarring. In African-American women or women of color, it is not unusual to have pigmentation changes associated with the scars, including hypopigmentation or hyperpigmentation. These can be reduced with certain lasers as well as with bleaching creams, including Hydroquinone. This should be discussed with your Board Certified Plastic Surgeon. Remember that scarring is never predictable and even though plastic surgeons will make every attempt to reduce scarring through excellent suturing technique, scarring is not within our control and that each patient will scar on an individual basis. Therefore, we can never guarantee the final results of any incision at any time.
Stuart Linder, M.D., F.A.C.S. is a Beverly Hills and Las Vegas Breast Revision Surgeon who enjoys performing breast augmentations, breast revisions, breast lifts, breast reductions and breast reconstructive surgery. He is a Diplomate of the American Board of Plastic Surgery and a Fellow of the American College of Surgeons and a Member of the American Society of Plastic Surgeons.
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Contributing Writer: Dr. Stuart A. Linder
Board Certified Plastic Surgeon
January 2006
"Rippling” Visibility of the Implant Edge
Stuart A. Linder, M.D., F.A.C.S. Las Vegas Breast Revision Specialist
4180 South Grand Canyon Drive Las Vegas, Nevada 89147
Phone: (702) 434-7205
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