Are scars avoidable?
Breast reduction, like breast enhancement, involves incisions in the skin. Scars are inevitable with any surgery, including breast reduction.
But this doesn't mean you'll necessarily be stuck with significant scarring. There are ways to reduce the appearance of scars during and after surgery.
Your first job is to find a high-quality, board-certified plastic surgeon who is experienced with breast reduction and minimal scarring. You can then try different techniques post-surgery to reduce breast reduction scars. Keep reading to learn more.
Different techniques leave different scars
Like any surgery, breast reduction leads to scarring. However, the extent of the scarring partly depends on the types of techniques used. This boils down to shorter-scar versus larger-scar techniques.
Be sure to ask about these techniques when you look at your surgeon's portfolio of work to get an idea of the differences between the two. This will help you learn what to expect post-surgery.
The shorter-scar technique in breast reduction surgery consists of smaller incisions. This method is used for people who experience sagging and want a minimal-to-moderate reduction in breast size.
People in this category will usually go down a cup size.
The limitation of short-scar reductions is their scope. Shorter-scar techniques aren't as effective for larger breast reductions.
Also called a "lollipop" or vertical breast reduction, this technique includes two incisions. The first incision is made around the areola, and the other is made from the bottom of the areola down toward the underlying breast crease. Once the incisions are made, your surgeon will remove tissue, fat, and excess skin before reshaping the breast to a smaller size.
Because these incisions are smaller, the scarring is condensed to a small area of the breast. Most scars are located on the lower half of the breast (below the nipple). These scars aren't noticeable above your clothing, and may be covered with a swimsuit.
As their name suggests, larger-scar techniques involve more incisions and subsequent larger areas of scarring.
This technique involves three incisions:
- one incision between the areola and crease under the breast
- another one around the areola
- one final incision horizontally beneath the breast (along the crease)
The larger-scar technique is used for an inverted-T ("anchor") breast reduction. You may be a candidate for this procedure if you have significant asymmetry or sagging. Your surgeon may also suggest an anchor reduction if you want to go down a few cup sizes or more.
Although this procedure seems more extensive, the larger-scar technique only involves one additional incision underneath the breasts.
What will the scarring look like?
Scarring from surgical incision looks like a thin, raised line on top of your skin. This is called scar tissue. At first, the area is red or pink in color. As the scar heals, it will darken and flatten. It may take several months to a year for your scars to fade. If you have darker skin, you may be at a greater risk for hyperpigmentation, or possibly thicker raised scars such as hypertrophic scars or keloids.
The appearance will vary between smaller and larger-scar techniques. With the latter, you will have three scars compared with two. Incisions made along the breast crease may not be as noticeable because they are horizontal and hidden in the breast crease, or bra line, itself.
Breast reduction scars shouldn't be visible in a bikini top or a bra. With an anchor breast reduction, some scarring might show along the crease of the breasts in minimal clothing.
Will the scars change over time?
If left untreated, breast reduction scars may become more noticeable over time.
Scarring may also be worsened by:
- excessive scrubbing
- itching or scratching the area
Your doctor is your best resource for information about aftercare and scar reduction techniques. They can walk you through your options and advise you on any next steps.
You shouldn't use over-the-counter (OTC) scar removal methods without consulting your doctor. Some products may increase your risk of rash and irritation, which may make the area of scarring more noticeable.
There's also little evidence that such products â€” even those with vitamin E â€” will work for surgery-related scars.
How to care for your scars and minimize their appearance
Long before the incisions of a breast reduction turn into scars, you should follow your surgeon's instructions for post-care.
Make sure you keep wearing chest bandages and your surgical bra for the first few days after surgery. You'll likely see your surgeon for a follow-up after this time. They'll advise you on how to take care of your skin as it heals.
Once the incisions close, there are scar-minimizing techniques you may consider trying during the healing process (but ask your surgeon first!). Your doctor may recommend more than one approach.
A scar massage is a technique involving gentle movements with your fingertips. Gently, you massage your scar vertically and then horizontally. You should also massage the scar in circles. This technique is thought to help increase collagen and flexibility, while also decreasing discomfort.
The Moffitt Cancer Center recommends starting scar massages about two weeks post-surgery. Daily massages of 10 minutes at a time are ideal. You can repeat the process up to three times a day.
Silicone sheets or scar gels
Silicone sheets and scar gels are OTC solutions for scars. Silicone sheets come in the form of bandages that have silicone in them. The idea is to hydrate the area of scarring to help make the skin more flexible. It may be helpful to use silicone sheets shortly after surgery because they can also reduce pain, itching, and other discomforts.
Scar gels, such as Mederma, may be used for fresh or old scars to help reduce their appearance. Over time, scars may fade in color and even shrink in size. Your doctor may recommend that you use a scar gel as soon as the incision heals. For scar gels to work, you must use them every day until you achieve the desired results. This may take up to several months.
Embrace dressings are U.S. Food and Drug Administration-approved bandages that are applied immediately after the incisions are closed post-surgery. These are designed to help pull the edges of your skin together to speed up the healing process. Embrace dressings also contain silicone, and they may be worn daily for up to one year.
A 2015 study discussed the effects of Embrace dressings on 36 people who recently had abdominoplasties. After 12 months, researchers noted significant scar reduction. However, similar studies on Embrace for breast reduction are lacking.
Long after your scars have healed, if they are overly dark or thick, fractionated laser may be an option. This treatment consists of microscopic lasers that can treat large areas of skin at once. They also target both the upper (epidermis) and middle (dermis) layers of skin, ensuring deeper scar removal. After treatment, the treated scar turns bronze temporarily before healing.
You may need multiple treatments spaced out every other month. According to DermNet New Zealand, four to five treatments may be necessary to achieve the desired effects. Fractional lasers may be used once your breast reduction scars have healed. This prevents potential complications, such as post-inflammatory hyperpigmentation.
It's important to wear sunscreen every day, even if your breast scars aren't directly exposed to the sun. UV rays can darken the newly created scar tissue after surgery. This will make the scars darker than the rest of your skin, thereby making them more noticeable.
Can you get the scars removed?
The only way to remove scars is through certain surgical procedures. These may be performed by your cosmetic surgeon or a dermatologist.
Scar removal procedures typically leave a new scar left in place of the previous scar. However, there's a possibility that the new scars will be smaller, finer and hopefully less noticeable.
One method of scar removal is called punch grafting. This procedure is primarily used for extremely deep scars that are smaller in size, but may be numerous and cover a large area.
Punch grafting works by plugging in skin from another area of the body (such as the ears) into the removed scar. The result is a smoother and shallower scar. Punch grafting takes up to one week to heal.
Other methods of scar removal may include:
- chemical peels
- laser therapy
- tissue expansion
- topical bleaching medications
The bottom line
Breast reduction scars are inevitable, but only to a certain degree. With the right surgeon, you may have minimal scarring post-reduction.
Before choosing a plastic surgeon, ask them for a portfolio of their work on breast reductions to see before and after pictures. This can help give you some insights into their quality of work, as well as the extent of scarring post-operation.
Your plastic surgeon can also give you tips for taking care of the areas of incision to promote the healing process.
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