Breast Reduction Scars | Prevention & Treatment

A scar is the formation of new fibrous connective tissue (collagen). This is a natural part of the healing process. Scar tissue is denser than normal tissue and has less pigmentation.

Normal scars tend to develop to a flat and pale colored state. Sometimes, depending on many factors such as genetics, location of the scar on the body, life style, and overall health., raised and or red or purple scars develop. These are hyperthropic or keloid scars. Silicone dressings have shown to be effective in the prevention and treatment of these types of scars.

There are several types of breast reduction scars because there are a few different basic surgical approaches used to perform breast reduction.

Anchor Scar (Inferior Pedicle)

The most common procedure of today involves the anchor incision pattern. This procedure is also called T-scar, T-incision, inverted T pattern, Weiss Method or BiLateral Reduction Mammoplasty.

A horizontal incision is made across the underside of the breast fold, a circular shape around the areola (the pigmented skin surrounding the nipple) and vertically from the areola down the front of the breast to the chest wall.



Keyhole Scar (Vertical Scar)

There's also the keyhole shaped incision around the areola and a vertical incision down to the breast crease. (Sometimes the ends of the vertical incision are extended with small horizontal incisions).

This procedure is also referred to as Vertical Mammoplasty, LeJour method, Vertical, Regnought, and The Lollipop Method. This procedure is only performed on women with a bust size of DDD or less which also have to meet some other criteria.

Copyright picture Wikipedia

Studies show that over 64% of women undergoing breast surgery develop a hypertrophic scar at three months after the operation. Avotermin, brand name Juvista is a medicine applied by injections in the skin just before surgery. The medication, derived from a protein observed in scar free healing embryos, has shown to promote skin regeneration thus minimizing scarring.

Silicone patches are the best scar treatment available for surgical scars. They are also used in burn centers and commonly recommended by dermatologists and (cosmetic) surgeons.

Although several studies have shown the efficacy of silicones it is still not exactly clear how they work. Hydration, the silicone substance as well as the pressure inflicted on the scar are thought to benefit scar reduction. This pressure is also why silicone patches have shown to be more efficient than silicone gels.

These dressings, also called sheets or patches, are a proven medical approach in order to improve the scar tissue by making it soft and smooth. They also neutralize the scar's color and will flatten raised scars. And they are known to prevent ugly scars from developing.

For breast reduction scars there are special shaped silicone patches available. These dressings from the Scar FX brand and from Rejuveness have an convenient advantage. Normal sheets have to be cut up into appropriate size and shape. This way it can be difficult to get them lined up.

The specialized breast reduction silicone scar sheets are self adhesive. This means they can be comfortably worn under clothing and pressure garments without being noticeable. They can even be kept on while showering, bathing or swimming.

"I love those silicone sheets. They have really helped my mast and node scars. I also bought those round areola sheets since my mast scar is around the areola. They are made of a thicker silicone.

I have worn that sheet over my areola almost nonstop since last July. I can hardly see the scar anymore. And those sheets are so thick I keep it on through showers workouts and everything. Every few days I take it off and wash with soap. Once it dries it just sticks right back on. I am only on my second areola silicone sheet since July. They are expensive but last sooo long I think it is worth it."

"We concluded that topical silicone gel is efficacious, both in the prevention and in the treatment of hypertrophic scar." source: Archives of Surgery

The silicone sheets should be applied when the wound is dry. (also only when the wound has been closed completely) They should be worn at least 8 hours per day up to a maximum of 24 hours. After 48 hours they should be cleaned with anti bacterial soap and dried with a towel.

The longer the silicone sheets are worn the better the final scar appearance will be.

Sheets should overlap the scarred area by at least 1 cm (1/4") all around. Tape that comes in the ReJuveness package can be used to hold silicones on scarred area.

Although most scar sheets are self adhesive but especially after wearing them and having cleaned them, they will become less sticky. Especially when treating bigger scars this can be a problem. Mostly after a few days the adhesiveness will decrease and you might have to keep them attached with silk, paper or other non irritable tape.

A common scar improving method after breast reduction is to leave the surgical tape on. The pressure of the tape divides the tension on the incision. It keeps the wound opening together which might result into less wide scars. It is common to keep the tape attached until it releases by itself. Surgical tape can also be reapplied.

I think it's best to keep the tape on while the wound is still a wound. Whenever the wound is closed I would recommend to start using silicone patches. This because a conclusion of a renowned dermatological report is that:

"Pressure therapy has demonstrated some efficacy but is cumbersome and not standardized."

Whereas the same report notes:

"the most accepted treatment for old and new hypertrophic scars is silicone gel sheeting".

Many women will prefer the use of liquid silicone gels. These are less cumbersome, significantly more convenient. Especially when someone wants to apply the product during daytime because it is less noticeable and stays on better.

Depending on how much movement the patches are subjected to they will let go eventually. This is where tape can come in handy. Still I would recommend to make use of the patches as much as possible because these have shown to be more effective than the creams. Personally I consider the creams an addition.

Silicone gel brands are ScarFade, Kelocote and Scarguard.

It is not possible to prevent a scar from developing completely. But there are factors that play a role in the creation of scar tissue. By trying to control these factors you are able to influence the outcome of the final scar appearance.

• Avoid overstretching the scars
  Especially in the early stage, when the wound has closed and has become a scar, it is important not to overstretch the tissue because this might widen the scar. Moderate exercising is preferred at least for the first months.



• Hydration
  Studies show hydration is very important in scar treatment. Thats why it is recommended to drink enough water. Avoid alcohol because this dehydrates the body. Silicone dressings and moisturizing creams also have a hydrating effect.



• Proper Wound Care
  Make sure to take good care for the wound and try to avoid infections because this will lead to extensive scar tissue developement. Research has shown that keeping wounds covered and moist makes them heal more quickly. Ask your doctor for advice.



• Healthy Diet
  Maintain a well balanced diet. Especially proteins are important because they are the building blocks of the body and are necessary to repair the wound and form little scarring. Foods containing proteins are meat, fish, dairy and soy products. Of course don't overdo it.



• Smoking
  Don't smoke or try to smoke less. Smoking is detrimental to the skin and delays the healing of wounds and scars. It also increases the risk of developing ugly scars.



• Positive Attitude
  This might sound overrated but the mind is powerful and how we think has a direct reflection on how we feel and (re)act. Not only regarding scar healing but also in general it is important to stay positive.

It is recommended to ask your cosmetic surgeon for instructions on how to massage the breast reduction scars. Scar massage can be started when the wound is completely healed. Don't start before because this will damage just healed tissue.

Scar massage benefits are the reorganization of collagen in the skin, stimulation of new tissue growth, reduction of tightness and scar pain, the increase of tissue sensitivity by improving the neurological function, the increase of blood circulation, which will lead to an overall improvement of scar appearance by a reduction of redness and elevation.


picture by: Haabet | Wikimedia Commons

Normally silicone patches can be used on the most sensitive of regions, such as the areola. In some exceptional cases women are allergic to silicone dressings. An alternative for women with such a sensitivity to silicone might be hydrogel sheets.

Polyurethane patches are also used effectively in treating scars. Although slightly less effective, especially for fresh scars, these could make an alternative for silicone pads.

The most common reasons for getting a breast reduction are headaches, shoulder, neck and back pain, infections and rashes and even finger numbness. Another reason is to get rid of the self conscious feeling some women with overly large breasts have to deal with.

Surgeons can't predict with certainty how the scar will turn out to be but with the right precautions and treatment the best result will be realized.

The liposuction scar reduction procedure is sometimes referred to as the 'scarless breast reduction'. This is not entirely true because there are smalll incisions made which subsequently will result in scars.

"This technique applies only to a very limited group of patients whose nipple-areoia complexes are normally located and whose enlargement is primarily fibrofatty in nature. Suction mammaplasty can be used as a sole technique in congenital asymmetry or in post-reduction enlargement or asymmetry."

(C)1991 American Society of Plastic Surgeons - Matarasso, Alan M.D.; Courtiss, Eugene H. M.D.