Scarring after Breast Reconstruction Surgery

An Interview with Dr. Carlin Vickery

Breast Reconstruction NY | Cosmetic Breast Surgery NYC

Q: Can you give us a brief description of what is involved in breast reconstruction surgery?

A: Breast reconstruction can take place simultaneously at the time of a mastectomy. The oncologic breast surgeon, who will be performing the mastectomy, and the breast reconstructive surgeon will review the optimal skin sparing incisions to ensure the most natural cosmetic breast reconstruction. Incisions to perform the mastectomy will first depend on whether the patient is having a nipple sparing mastectomy or a nipple/areola removing mastectomy.

The reconstructive surgeon will take into account the size of the breast, the location of previous scars, previous radiation and the elasticity of the patient's skin; each of these factors will contribute to the decisions regarding the size and location of the mastectomy scar. If a patient is having an autologous reconstruction (utilizing their own tissue to reconstruct the breast) the surgeon has greater freedom in the location of the scars as the underlying tissue will have its own blood supply, making for a faster healing process.

If a patient is having an implant reconstruction then, optimally, the mastectomy procedure will avoid a vertical scar on the lower pole of the breast as this area will not have underlying protective muscle. Without muscle the remaining overlying skin is more fragile and therefore avoiding an additional scar in this area reduces the risk of post-mastectomy skin loss and infection. An experienced reconstructive plastic surgeon will consider all of these factors before determining the mastectomy incisions.

Q: What are the types of scars that can result before/after the procedure and where?

A: Scars range from an oblique short, elliptical scar across the mid-portion of the breast to the standard vertical scar utilized for cosmetic mastopexy and breast reduction. In general, a surgeon will keep any scar as short as possible, most of which will be invisible once the patient has their nipple/areola reconstruction whose area will cover two-thirds of most oblique scars. The remaining part of the scar will fade and will not be visible unless closely inspected.

Q: Are there any treatment options provided by doctors to help heal physical scars?

A: Final scarring is ultimately determined by a patient’s own biology and how the individual lays down collagen (proteins that form strong fibers that serve as connective tissue between cells and knit together the fiber inside the body). The surgeon optimizes the chance for a good scar by carefully selecting the location of the scar, handling the tissues and sewing any incision with fine sutures.

Post-operatively, it is important to keep the scar free of moisture and heavy crusting. This is achieved by carefully cleaning the scarred area and moisturizing with an antibiotic ointment. After several weeks, the patient can apply a scar cream to further optimize healing by reducing the inflammatory response of the body. The best scar treatments include a bit of steroid as well as a silicone surface to enhance collagen healing.

Q: Are there any home or over-the-counter remedies that will help to alleviate some of the scarring?

A: There are a number of scar treatments on the market. Some include silicone strips which are placed over the scar and help the collagen to heal at a rapid rate. There is also a light, nail polish-like liquid that includes a small dose of steroid as well as the lubrication that the silicone strips provide.

Many scars will respond with a shorter, red, inflammatory phase resulting in a lighter and flatter looking scar. There are some patients who create large amounts of disorganized collagen healing bonds due to their biology. These patients may develop hypertrophic scars (excessive growth) which may require direct injection of steroid to reduce the inflammation. Scars can also be treated with lasers where some patients show a reduction of blemishing.

Q: What advice do you give women who worry about scarring?

A: I always ask the patient to show me any pre-existing scars during a breast reconstruction consultation. I find that this is the best way to get an early indication of whether the patient generates invisible or hypertrophic scars. It is important to tell patients that not all parts of the body heal in identical ways. Most patients heal in a satisfactory fashion if their scars are closed with fine plastic surgery techniques.

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Categories: New York Plastic Surgery Blog