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Breast Scars

Breast Scars resulting from Cosmetic Breast Surgery

There are basically three main reasons patients develop keloids on the breast.  Breast keloid scars are usually caused by trauma, breast surgery, or acne.  In my practice, I have found that many female patients with scars on the breast avoid consultation because of embarrassment or a false belief that there is nothing that can be done to treat the scars.  Nothing could be further from the truth, as breast scars are among the most amenable to treatment.  Breast scars that develop from surgery are usually correctable with laser, chemical peels, IIT, TAC injection, and silicone occlusion.  In severe cases, surgical revision is performed to remove the breast scars in their entirety.

Patients with breast scars resulting from breast biopsy, lumpectomy, mastectomy, or breast surgery can also be helped with various modalities of treatment.  Usually, patients who have undergone breast surgery for cancer or biopsy have issues relating to a loss of breast volume and poor surgical scars.  Both issues can be improved with surgery.  Breast scar revision can be used alone or in combination with laser, chemical peels, silicone occlusion, IIT, or TAC injection to improve scars.  If there is permanent volume loss due to the breast biopsy or lumpectomy, there are several treatment protocols that can improve the shape and volume of the breast. 

A breast biopsy, lumpectomy, or partial mastectomy can be performed with small incisions that are oriented tangentially or radially from the circumference of the areola. These scars usually heal without noticeable scarring, but in rare occasions, may become a sentinel element of the breast aesthetic.  Scars may become thickened, red, painful, raised, and indented.  Scar retraction may lead to breast deformity and removal of breast tissue may sometimes lead to indentation of the breast or asymmetry. 

Fortunately, all of these breast scar types can be improved with laser, topical polysiloxane gel such as Plato's Scar Serum, and surgery.  The most difficult element of breast scar reconstruction is deciding the order of treatment. Non-surgical treatments for breast scars include pulse dye laser, 595 nm VBeam laser, Yag laser scar revision, compression therapy, silicone occlusion therapy, IIT, TAC Injection, and pressure management.  Surgical options for scar revision includes surgical excision, serial excision, scar modification, z-plasty, w-plasty, and y-plasty scar revision surgery.

Patients who are concerned about breast surgery scars before having surgery may wish to read about a newer technique for breast reduction and breast lift surgery.  The technique is known as a 'short scar' breast reduction or 'short scar' breast lift.  In both techniques, the breast scar is minimized to approximately one-third of the scars that develop in a traditional breast lift. Short scar breast lifts and Short scar breast reductions typically have a scar that encircles the areola and progresses from the base of the areola to the midpoint of the inframammary fold. The following diagram emphasizes the difference between the short scar and traditional breast surgeries.  Dr. Karamanoukian performs the Short Scar Lift or Reduction almost exclusively to minimize scars with breast surgery.

Areola Scars:

The areola represents the pigmented skin surrounding the nipple on the breast. Surgeons refer to the nipple and the areola collectively as the nipple-areolar-complex (NAC). Even in the best of hands, the areolar skin can develop noticeable scarring that can detract from the aesthetics of the female breast. The scarring can result from injury, cosmetic surgery, or any other type of skin injury. Most areolar scars are either hypertrophic, keloid, hyperpigmented, thickened, hypopigmented, or red. If you are concerned about areolar scars, there are many excellent examples available in our Santa Monica plastic surgery practice that can help improve the cosmetics of your breast. 

Hyperpigmented or hypopigmented scars around the areola can often be a challenge to treat, as the areola is usually a transition zone between light and dark skin. It is often difficult, but still possible, to realign the skin colors to match the normally darker areolar skin and the lighter breast skin. Hyperpigmented scars are usually treated with a mild exfoliant such as Melapads + a series of skin lighteners such as Melarase AM and Melarase PM.  Hypopigmented areolar scars are more difficult to treat, as it is a challenge to recreate pigment in an area of depigmentation. Nonetheless, surgical and fractional co2 options are available to recreate the natural transition between the areas of skin. 

Hypertrophic and keloid scars remain a challenge in areolar scar revision. These two types of scars are usually a result of cosmetic breast surgery such as a breast lift, breast reduction, or breast augmentation. Thick scar tissue can be modulated with topical application of Plato's Scar Serum, vascular laser to disrupt scar formation, and ablative laser to help improve surface texture. Some patients may also require injection therapy to help soften thick areola scars. 

Breast Implant Scars: Breast implant surgery can be performed with either a periareolar incision, inframammary crease incision, umbilical incision, or axillary (armpit) incision. Each of these incisions can lead to scarring. The two most common incision-types employ the inframammary crease and periareolar techniques. These breast implant incisions can become hypertrophic, hypopigmented, hyperpigmented, texturally smooth, widened, raised, inflamed, keloid, or indented. If any of these patterns of scar formation exist, they may limit the aesthetic gains achieved by augmentation mammaplasty. Breast implant surgery can lead to permanent scarring that can usually be repaired with lasers, IIT, topical therapy with Plato's Scar Serum, and microtherapy for scars. 

Breast Keloids: Abnormal scarring on the breast is usually a result of surgery, but some keloids can form as a result acne, cysts, or burns. Chemical burns, heat burns, even curling iron burns can cause keloids to form on the breast. In our Los Angeles office, we see patients with many different types of breast keloids, some of which have unknown causes. If a breast keloid is formed as a result of surgery, the keloid is usually localized to the area of the incision-line. Keloids of the areola and breast from cosmetic surgery can be treated with surgical scar revision, lasers, injections, and topical treatments. Breast scars resulting from a burn or acne pimple are often not as responsive to surgery and thus cannot be controlled with surgery alone; a combination of lasers, injections, and topical therapy may be indicated. 

Anesthesia for Scar Revision: Our board certified plastic surgeon and breast implant revision specialist hold privileges at Providence St. John's Hospital in Santa Monica and several ambulatory surgical centers in Santa Monica and Beverly Hills. Breast implant revision or scar treatment can vary in terms of severity and thus the choice for anesthesia can vary from a very light local anesthesia to complete general anesthesia. Local anesthesia is an excellent choice for most small surgical scar repairs. Lidocaine can be used safely to anesthetize the skin and soft tissue of the breast in order to perform minor scar revision procedures. For more complex surgery, regional or general anesthesia is requested. In our surgical center, we use board certified anesthesiologists who are trained in cosmetic surgery. The depth of your general anesthesia or conscious sedation will be addressed during your preoperative consultation. 

Prevention of Breast Scars: If you are reading this and are considering either breast scar revision or breast enhancement surgery, one of the most important items to consider is scar prevention. There are many different steps you can take to minimize future scarring after a breast procedure. Dr. Karamanoukian is a dedicated cosmetic plastic surgeon and can help you reduce your existing scarring or help you avoid the development of scarring in the future should you choose to undergo a cosmetic breast procedure. Following your surgeons advice can help you achieve the very best results possible. The most common types of cosmetic breast procedures include breast augmentation, breast lift, and breast reduction. Once the surgery is complete, keep the area free of excessive moisture or contamination. In our office, we use steri-strips to minimize postoperative scarring. Once the skin has healed and the sutures are removed, Dr. Karamanoukian will recommend either continuation of the steri-strips or application of a scar gel such as Plato's Scar Serum. Silicone scar gels are among the most effective scar creams and can help you avoid future scarring. Application of the Plato's Scar Serum twice daily can help reduce your scars. Further, the pulsed dye laser and judicious use of IIT can help minimize the potential for scarring. 

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