Breast augmentation scars rarely form keloids because they are not under tension. Conversely, breast reduction or breast lift incisions have a higher incidence of hypertrophic (thick) scars.

Published on Jul 11, 2012

Most individuals confuse keloid with hypertrophic scar. A keloid is a thick, hard, sometimes itchy scar, while a hypertrophic scar appears to be spread. Proper tissue technique will help minimize your risk, but nothing will stop a keloid if your body tends to form them. Good luck.

Published on Jul 11, 2012

I still use the inframammary approach. Observe for early signs of thickening. If this occurs, inject with 5-FU and Kenalog.

Published on Jul 11, 2012

I would recommend not having the incision for placement of the implants below the breast or through the armpit, for if you have bad scars, it will show there much more!

Published on Jul 11, 2012

Thank you for your question. Here at Shumway Cosmetic Surgery, we perform a scarless breast augmentation called TUBA (trans-umbilical breast augmentation), which is performed through the belly button. There is no cutting, hence no scarring. And for this reason, too, the recovery is much quicker. The approximately hour-long procedure is performed under local and IV sedation, and patients feel much better after 3 to 5 days.

Published on Jul 11, 2012

Your body may react differently this time, but we can deal with that when or if it happens with either laser or injectables treatment.

Published on Jul 11, 2012

Keloids are an abnormal healing response when the scar grows beyond the initial injury or incision. If treated with surgical excision alone there is a 50% chance of recurrence. Excision is usually combined with steroid (kenalog) injections, chemotherapy injections (5FU), or radiation treatment. Hypertrophic scars are raised and angry looking but are in the confines of the initial injury or incision. It is best to consult with a Board Certified Plastic Surgeon to see if you have keloids or hypertrophic scars and to weight the pros and cons of having elective cosmetic surgery with the risks of poor scarring. The only way to minimize the risk of a keloid scar is with a minimal scar,such as with TUBA the single belly button incision.

Published on Jul 11, 2012

I have had many patients claim that they get keloids, when in fact, they have usually had hypertrophic or wide scars. The reason someone gets a hypertrophic scar may have to do with how the wound or incision was originally treated or with the persons own healing tendencies. I can say that many patients who have had a history of hypertrophic scars have had very nice scars when they had breast augmentation, whether it was done through the areola or inframammary crease. I would not change how I do the surgery unless I was convinced they had a true keloid history that I could verify.

Published on Jul 11, 2012

Thank you for your question. A breast augmentation can be performed through several approaches: periareolar (nipple), inframammary (the crease), or transaxillary (armpit). If you have a tendency to form thick, hypertrophic, or keloid scars, that process can occur with any incision. My recommendation would be the inframammary or transaxillary incision as they may be least visible. I would recommend the use of fine subcuticular sutures (beneath the skin surface) with steristrips to reduce the tension along the incision surface. I would also recommend early postoperative scar treatment beginning approximately 2 weeks postoperatively. There are numerous scar creams and topical gels available to treat postoperative incisions. I have found Embrace scar therapy works very well when initiated 2 to 3 weeks postoperatively. Liquid silicone preparations such as Kelocote and Scar Guard are also very effective. If you are unfortunate, and develop a keloid scar, it can be treated with steroid injections as indicated.

Published on Jul 11, 2012

Good afternoon!
I think it is important for your surgeon to be gentle and create as little trauma as possible, and to suture the wounds carefully, and then start topical wound treatment early in the postop period!
Take care

Published on Jul 11, 2012

Great question. Most patients that think they have a tendancy to scar poorly or keloid often do not. Often, the injuries occurred in ways that tend to heal poorly or are located in problematic areas but not really related to the healing tendancy of the individual. Even if a tendancy to keloid was present an incision in the breast fold will likely still be the best option.

Published on Jul 11, 2012

In general, breast augmentation scars heal very well, even if the person has had hypertrophic or keloid scaring elsewhere. There are three locations to place an incision, the inframammary fold, around the areola, and in the armpit. Each has it's pluses and minuses. Some are overall more favorable than others. None are not recommended for those that scar poorly elsewhere on their body.

Published on Jul 11, 2012

Limiting scars in breast augmentation can relate to implant type and size choice. Saline breast implants require smaller incisions as compared to silicone breast implants. Larger and more cohesive ( gummy bear) silicone breast implants will require a longer incision and place more stress on the breast skin which all can lead to scar formation. Silicone based scar care can as well help with healing scars.

Published on Jul 11, 2012

Thank you for your question. Keloid scarring is a form of abnormal scarring that is genetically determined, and thus cannot necessarily be avoided in surgery on susceptible individuals. However the first determination is whether there is a tendency to true keloid, or just a tendency to heavy scarring, which is not a genetic anomaly, and is more related to scar location and orientation. Whereas true keloid scars have a tendency to grow outside of the area of the wound, invading adjacent tissues, simple heavy scars (or hypertrophic scars) stay within the confines of the original wound. Collagen ratios in keloid scars is also abnormal when the tissues are tested. The best way to avoid a heavy scar on the breast with augmentation is to use a route that does not place a scar on the breast. The trans-axillary approach that I use is appropriate in this situation, as at least there is not a problem with a potentially scar on the breast. I hope that this helps.

Published on Jul 11, 2012

When a patient has keloiding tendencies, I place the incision under the breast at the fold. It is the only place where the incision is hidden as your breast will cover it.

Published on Jul 11, 2012

If you truly keloid, then there is not a lot that can be done to fully prevent this. This is a genetic response to healing, and is not really susceptible to regular scar treatments. I usually recommend using permanent sutures that need to be removed after a week or two since these are less reactive then dissolving sutures, as well as silicone sheeting products afterwards on the scars. Topical steroid can help as well once the incision is healed sufficiently. I hope this helps.

Published on Jul 11, 2012

Keloid scarring is definitely a concern. There is no way to prevent it but there are methods to reduce the risk. Early scar treatment with pressure massage, Vit E and use of silicone gel strips are simple ways to help reduce the risk. Also, keloid scarring is often misdiagnosed. I would recommend discussing your scarring from previous surgeries with your surgeon to determine if you actually form keloids. Also, placing the scar in a more hidden location like in the bottom fold of the breast is another method to hide the scarring.

Published on Jul 11, 2012

Yes, there are many options regarding this and i recommend you discuss with a board certified plastic surgeon in your area, best of luck.

Published on Jul 11, 2012

The incidence of keloid scarring in the areolar incision is extremely rare and in keloid prone individuals, this may be a preferred approach

Published on Jul 11, 2012