Scarring

NONE. Life has so much more meaning than a disfiguring scar, or a hidden one. LIVE, LAUGH, and LOVE the one your with! None. Seriously, it is not as bad as people think.

Many women are candidates for incision via the inframmamary fold (the bra line). I had mine done this way and one can hardly tell that I had a mastectomy. This is often available for small and medium breasted women, less so for women with large breasts. Be sure to discuss this option with your doctor to see if you are a candidate. Many do not offer this option, so be sure that you determine if you are not a candidate or if your surgeon simply does not offer the procedure. The incision will vary with the type of mastectomy being performed, and whether or not there is reconstruction. For example, in nipple-sparing mastectomy (NSM), one incision is made (which can be placed in several different ways, extending laterally from the edge of the areola, or vertically down from the areola being two examples). The incision length with vary with breast size. NSM is done in conjunction with immediate breast reconstruction. With skin-sparing mastectomy (SSM), the nipple and areola are removed, and the majority of the breast skin is left to provide a bigger skin envelope for reconstruction. For mastectomy without reconstruction, the incision is necessarily larger, as the goal is to have the remaining skin flaps lie flat on the chest wall. That way a prosthesis can be worn more easily.

In patients prone to keloid, steroid can be injected into the wound at the time of closure (Kenalog10) to minimize an exuberant scar.

The amount of scarring depends on the technique the surgeon uses for the mastectomy. Generally, skin sparing mastectomies have less scars. The amount of scarring depends on the technique the surgeon uses for the mastectomy. Generally, skin sparing mastectomies have less scars.

Scars are permanent but to improve their appearance we start a scar control program 3 weeks after surgery and continue it until the scars are flat, smooth and the right color. Scars are permanent but to improve their appearance we start a scar control program 3 weeks after surgery and continue it until the scars are flat, smooth and the right color.

Melanoma surgery is often undertaken with a team that includes a plastic surgeon for the more complicated wounds or more cosmetically sensitive areas (particularly face, ear, hands, genitals). If you are unhappy with your surgical scars, a plastic surgical consultation is often recommended by the surgical oncologist. Melanoma surgery is often undertaken with a team that includes a plastic surgeon for the more complicated wounds or more cosmetically sensitive areas (particularly face, ear, hands, genitals). If you are unhappy with your surgical scars, a plastic surgical consultation is often recommended by the surgical oncologist.

The only proven scar reduction treatment is silicone bandages. They need to be applied to the scar continuously for best results. The bandages are sold in most drug stores or medical (bandage) supply stores or online (search 'silicone bandages'). The bandages usually are 'tacky' and stick to the scar. They can be used as soon as the wound is healed. They can be removed for bathing/showering and are reusable. Hypertrophic scarring and keloids can occur on any skin type and after many different types of skin trauma (surgery, piercings, acne, etc). Treatment of early excessive scarring can be with silicone bandaging but often requires more extensive treatment such as steroid injections, re-excision of the scar, or even radiation treatments! The only proven scar reduction treatment is silicone bandages. They need to be applied to the scar continuously for best results. The bandages are sold in most drug stores or medical (bandage) supply stores or online (search 'silicone bandages'). The bandages usually are 'tacky' and stick to the scar. They can be used as soon as the wound is healed. They can be removed for bathing/showering and are reusable. Hypertrophic scarring and keloids can occur on any skin type and after many different types of skin trauma (surgery, piercings, acne, etc). Treatment of early excessive scarring can be with silicone bandaging but often requires more extensive treatment such as steroid injections, re-excision of the scar, or even radiation treatments!

By far the best result and state of the art today involves Nipple Sparing Mastectomy(NSM) and immediate reconstruction with DIEP or other Perforator flaps. For an optimal outcome, it is crucial to have a breast surgeon well trained in NSM and the right plastic surgeon. Ideally a one stage mastectomy and reconstruction can be done. Typically the breast would have a faint scar on the under surface of the breast. The DIEP donor site should be the same as a cosmetic tummy tuck. If the abdomen is not a good option, skin and fat can be obtained from the posterior thigh leaving a scar concealed in the fold beneath the buttock. This is my most recent innovation and is called the PAP flap. By far the best result and state of the art today involves Nipple Sparing Mastectomy(NSM) and immediate reconstruction with DIEP or other Perforator flaps. For an optimal outcome, it is crucial to have a breast surgeon well trained in NSM and the right plastic surgeon. Ideally a one stage mastectomy and reconstruction can be done. Typically the breast would have a faint scar on the under surface of the breast. The DIEP donor site should be the same as a cosmetic tummy tuck. If the abdomen is not a good option, skin and fat can be obtained from the posterior thigh leaving a scar concealed in the fold beneath the buttock. This is my most recent innovation and is called the PAP flap.

Best to consult with a physical therapist to help design a program for increasing flexibility and scar management. Best to consult with a physical therapist to help design a program for increasing flexibility and scar management.

Now more than ever, surgeons are paying attention to the overall cosmetic results of a lumpectomy. It is no longer good enough just to preserve the breast - the goal should be breast preservation with as normal a shape and contour as possible. Oncoplastic techniques which combine cancer and plastic surgical techniques, allow for removal of tumors and some "rearranging" of tissue to leave a more natural cosmetic result - sometimes a combined approach where the breast surgeon and plastic surgeon work together is an option as well. Incision placement is important - some areas of the breast heal and scar differently than others. Of course we're often limited by the location of the tumor - something we can't change.

The use of ultrasound in the operating room by the surgeon allows the surgeon to more precisely determine where the cancer is and the appropriate amount of tissue to remove, reducing the amount of normal breast tissue that is removed, and reducing the need to return to the operating room for additional surgery. Finally, some newer surgical tools have been developed - my favorite is the PEAK PlasmaBlade - it is an electrosurgical tool that allows me to dissect through tissue and seal blood vessels, but it generates less heat than our standard electrosurgical tools. This means less damage to normal tissue, and improved healing.

Do realize that despite all of these techniques, the treated breast may wind up being smaller than prior to surgery and radiation. Federal law requires that insurance companies cover reconstructive procedures to the unaffected breast if needed to restore symmetry. Now more than ever, surgeons are paying attention to the overall cosmetic results of a lumpectomy. It is no longer good enough just to preserve the breast - the goal should be breast preservation with as normal a shape and contour as possible. Oncoplastic techniques which combine cancer and plastic surgical techniques, allow for removal of tumors and some "rearranging" of tissue to leave a more natural cosmetic result - sometimes a combined approach where the breast surgeon and plastic surgeon work together is an option as well. Incision placement is important - some areas of the breast heal and scar differently than others. Of course we're often limited by the location of the tumor - something we can't change.

The use of ultrasound in the operating room by the surgeon allows the surgeon to more precisely determine where the cancer is and the appropriate amount of tissue to remove, reducing the amount of normal breast tissue that is removed, and reducing the need to return to the operating room for additional surgery. Finally, some newer surgical tools have been developed - my favorite is the PEAK PlasmaBlade - it is an electrosurgical tool that allows me to dissect through tissue and seal blood vessels, but it generates less heat than our standard electrosurgical tools. This means less damage to normal tissue, and improved healing.

Do realize that despite all of these techniques, the treated breast may wind up being smaller than prior to surgery and radiation. Federal law requires that insurance companies cover reconstructive procedures to the unaffected breast if needed to restore symmetry.

the scar for a mastectomy depends on whether an immediate reconstruction is performed, in which case the scar may be smaller, depending on how the operation has been planned with the plastic surgeon. without reconstruction, the scar depends on various things such as the size of the breast and the size of the areola. the scar for a mastectomy depends on whether an immediate reconstruction is performed, in which case the scar may be smaller, depending on how the operation has been planned with the plastic surgeon. without reconstruction, the scar depends on various things such as the size of the breast and the size of the areola.

Today there are many options for mastectomy, especially for those with early stage cancer. In the past, most doctors made incisions across the breast or on the side of the breast. Today, many doctors perform this surgery from the underside of the breast, where scars are less noticeable. Why don’t all doctors do this? Some may be reluctant to learn new methods, and for others, perhaps they can’t be bothered. This type of surgery takes longer; surgeons are paid by the job, not the hour. Removal of the nipples is not always necessary. Doctors used to believe that nipple-sparing mastectomies were not effective because breast tissue remains. However, today, many doctors realize that sparing the nipples does not increase your risk of recurrence as long as the cancer is not in or near the nipples. When I was facing mastectomy, I wanted a doctor with cutting-edge thinking, someone who continuously learns new ways to perform surgery. If your doctor does not offer you options or is only able to give you ‘your mother’s mastectomy’, find a new doctor. After all, you wouldn’t buy an outdated cell phone, so why in the world would you accept outdated surgery?
I urge you to view the following link regarding nipple-sparing, beautiful mastectomies. Please note I do not agree with their discussion of incision placement, but if you follow the forum, you will hear others talk of below the breast placement.
http://community.breastcancer.org/forum/44/topic/745796
Today there are many options for mastectomy, especially for those with early stage cancer. In the past, most doctors made incisions across the breast or on the side of the breast. Today, many doctors perform this surgery from the underside of the breast, where scars are less noticeable. Why don’t all doctors do this? Some may be reluctant to learn new methods, and for others, perhaps they can’t be bothered. This type of surgery takes longer; surgeons are paid by the job, not the hour. Removal of the nipples is not always necessary. Doctors used to believe that nipple-sparing mastectomies were not effective because breast tissue remains. However, today, many doctors realize that sparing the nipples does not increase your risk of recurrence as long as the cancer is not in or near the nipples. When I was facing mastectomy, I wanted a doctor with cutting-edge thinking, someone who continuously learns new ways to perform surgery. If your doctor does not offer you options or is only able to give you ‘your mother’s mastectomy’, find a new doctor. After all, you wouldn’t buy an outdated cell phone, so why in the world would you accept outdated surgery?
I urge you to view the following link regarding nipple-sparing, beautiful mastectomies. Please note I do not agree with their discussion of incision placement, but if you follow the forum, you will hear others talk of below the breast placement.
http://community.breastcancer.org/forum/44/topic/745796

Hi Rose,

Have you tried massage or reikki (sp)? Both of them helped me to much. I had two flap reconstructions on the same breast, one from the back and two years later from the stomach. I saw a massage therapist twice a month for almost a year after each surgery and right after the surgery I had the reikki and after I could lay on the table I added the massage. I found a massage therapist experienced with scar tissue and breast cancer and he was a life saver. If I could afford it I would do it every week!

I know it takes my body a long time to get my scars to lay down fade on the skin and it took a long time to feel "normal" after the TRAM but now, three years later, most days I don't even think about it.

Warm regards,
Nancy Hi Rose,

Have you tried massage or reikki (sp)? Both of them helped me to much. I had two flap reconstructions on the same breast, one from the back and two years later from the stomach. I saw a massage therapist twice a month for almost a year after each surgery and right after the surgery I had the reikki and after I could lay on the table I added the massage. I found a massage therapist experienced with scar tissue and breast cancer and he was a life saver. If I could afford it I would do it every week!

I know it takes my body a long time to get my scars to lay down fade on the skin and it took a long time to feel "normal" after the TRAM but now, three years later, most days I don't even think about it.

Warm regards,
Nancy

Scar tissue is dense fibrous connective tissue that forms over and/or around a healed wound or cut. Scar tissue is the body's way of repairing and protecting damaged tissues. Scar tissue is dense fibrous connective tissue that forms over and/or around a healed wound or cut. Scar tissue is the body's way of repairing and protecting damaged tissues.

The first thing to do is to lightly stretch and massage the scar area daily (especially during the first year, when most healing occurs). When massaging, gently cross the incision from side to side. Also while massaging, be alert for lumps around or under the scar tissue, which might indicate reoccurrence.

Ointments may also be used. Some examples are eucerin, bio skin repair, scarprin, dermatix, ultratalsyn, zen-med, kelocote, and woundbegone.

Physical therapy could help if the scar tissue is causing stiffness, pressure, or pain.

Consult your doctor if the scar tissue is very painful. The first thing to do is to lightly stretch and massage the scar area daily (especially during the first year, when most healing occurs). When massaging, gently cross the incision from side to side. Also while massaging, be alert for lumps around or under the scar tissue, which might indicate reoccurrence.

Ointments may also be used. Some examples are eucerin, bio skin repair, scarprin, dermatix, ultratalsyn, zen-med, kelocote, and woundbegone.

Physical therapy could help if the scar tissue is causing stiffness, pressure, or pain.

Consult your doctor if the scar tissue is very painful.