A prominent concern of patients undergoing cosmetic breast surgery with Brisbane plastic surgeon Dr. Philip Richardson is how noticeable scars will appear post-operatively. Scarring is one of those variables that is difficult to predict and is extremely subjective to each patient. It’s hard to accurately understand how a patient will heal post-operatively, but there are measures we can take to minimise the appearance of scars after breast surgery. This blog post aims to equip patients with the information they need about breast surgery scars.

Types of Scar Formations: Breast Lift Mastopexy & Breast Augmentation Mammoplasty Scars

Different breast surgeries will have varying incisional techniques, and result in different scar formations. For a standard breast augmentation mammoplasty, the scars will be most discreet, as the incision is placed under the breast fold and in most cases will be covered by the breast tissue and implant. The scar may be visible however when lifting the arms up in a bikini, or without a bra. Breast lift mastopexy and breast reduction mammoplasty are the more common procedures where patients cite scarring as a prominent concern. For these two procedures, Dr. Richardson’s most popular incisional technique is the anchor pattern. The anchor pattern involves a scar circling around the nipple, down the middle of the breast, and along the inframammary fold. Some surgeons also perform techniques such as the donut lift, or crescent lift, which minimise scarring but limit the ability to manipulate breast shape and size.

Risk Factors 

Most patients will know before their consultation whether they are at higher risk of scarring. Scar history is something that is discussed with Dr. Richardson at your consultation, as this will determine the most likely outlook for your breast surgery scars. If you are a patient that has had previous surgery or injury resulting in noticeable scarring, this will likely be the case for your breast surgery. There is a scale of skin types referred to as the Fitzpatrick Scale which helps to predict the scarring risk for patients. The scale is as follows:

The Fitzpatrick Scale can provide patients with an idea of whether they are at a higher risk of scarring. Of course, this scale does not rule out the possibility of a patient with very fair skin having noticeable scarring, but provides a framework for most common effects. Patients of Asian, African, or Mediterranean/Middle-Eastern descent are at higher risk of scarring due to their darker skin tone.

Patients that are constantly exposed to the sun are also at higher risk of scarring, as sun exposure can cause pigmentation of the scar, and can also induce inflammation and redness. It’s important to avoid UV rays to prevent hyperpigmentation of the scars.

Types of Scars

There are different types of scars that can form and the level of treatment required for each will vary. Normal fine-line scars will leave a raised line (like the incision of breast surgery) and will gradually fade and flatten. A keloid scar may form however, and this occurs when there is an overgrowth of tissue due to excess collagen production. The keloid scar can take on a red or dark appearance, and will extend beyond the bounds of the original incision to create a larger scar. The keloid scar can be uncomfortable due to the itching sensation it can have.

Similarly, hypertrophic scars are due to excess collagen production, however they are contained to the incision, and will not extend beyond the boundary of the wound. There is not necessarily a reason keloid and hypertrophic scars develop. Research suggests that the genetics of the patient—as per the Fitzpatrick Scale—plays a role in this type of scarring.

The most promising outlook for patients when met with the concern of scarring is to understand key prevention techniques that can minimise the risk of these types of scars forming.

Prevention of breast lift mastopexy and breast augmentation mammoplasty scars

There are a number of preventative measures that can be taken prior to, and after breast surgery to avoid the formation of hypertrophic or keloid scarring, and reduce the appearance of fine-line scars. From an internal perspective, nutrition, hydration, and avoiding smoking are all integral to proper scar healing.

From an external perspective, using bio-oil on the breasts for the weeks leading up to surgery can help prep the skin for not only the stretching caused by the implant, but also the healing of the skin following incision. The bio-oil can help facilitate increased elasticity and prevent stretch marks and scarring post-operatively. After the operation, patients should keep their surgical tape on for 6 weeks to ensure proper healing of the incision and appropriate support on the incisions. However, no bio oil or any ointments should be placed on the scars in the first 6 weeks, as this will run the risk of infection.

After the 6 week mark, patients can start using the bio oil once more on the breasts and the incisions to help manage scarring. Vitamin E cream and Vitamin E oil has also been found to be highly beneficial for this purpose. Patients should keep their incisions out of the sun to avoid hyperpigmentation, so avoiding exposure, and ensuring appropriate coverage is paramount to results. 

One of the most effective methods to preventing the formation of hypertrophic and keloid scarring is silicone tape. Silicone tape can keep pressure on the incisions and reduce collagen production and redness of the scars. You can also combine silicone tape and silicone gel.

Management of breast surgery scars

In the event that a patient does develop hypertrophic or keloid scarring, there are a number of treatment options that are available.

Steroid cortisone injections may be administered by a doctor or dermatologist to reduce the size of the scar. Steroids break the bonds between collagen fibres, which subsequently minimises the amount of scar tissue. Follow-up treatments may be required for optimal results, and consistent silicone tape between treatments and longer term will yield the most positive difference.

LED light therapy is another option that can help in the management of scarring. Red light therapy can reduce inflammation and also support tissue repair and regeneration. Red light therapy can encourage normal collagen production. This helps replace scar cells over time and minimise the appearance of the scar. Here at Brisbane Plastic & Cosmetic Surgery we offer LED light therapy to our patients to help manage wound healing. We perform multiple LED light therapy sessions, combined with a consistent silicone tape regimen.

In very severe cases of keloid scarring, the patient may have the scar surgically removed however this runs equal risk of the scar forming a second time. This avenue is a last resort and you should discuss all options with your surgeon prior to undergoing such treatment.

Breast Practice in Managing Breast Lift Mastopexy and Breast Augmentation Mammoplasty Scars

In this blog post, we have considered the different scar formations of breast surgery. We also considered the risk factors associated with scarring. These include skin type and genetics. Finally, we looked at the prevention of scars, and the management of existing scars. What did we learn? You should follow the following steps when planning for breast surgery:

         1. Identify your risk factor, and understand your scarring history

         2. Employ key prevention techniques

         3. Begin consistent treatment early (after the 6 week mark)

         4. Be consistent with your regimen, and reach out to your surgeon if you are developing more severe scarring.

If you have any questions regarding any of the information outlined in this article, or if you’re ready to book your initial consultation with Brisbane plastic surgeon Dr. Philip Richardson, don’t hesitate to call us today on 07 3268 3774, or contact us here.