Areola Scar Tissue Buildup started at ~2 months post op

[waves]

At about 2 months post op me areola incisions started to build up significant scar tissue.  Now at 10.5 weeks post op my areola's protrude from my chest about 5mm.  The protrusion is primarily at the incision point (bottom of the areola), but now gives somewhat of a puffy nipple appearance.

Unfortunately my surgeon is on the other side of the country so hoping some advice on how common this condition is or tips to reduce the scar tissue build up.

Some facts:

- gyne first appeared about 15 years ago and became stable after 3 years (so now 12 years stable gyne)
- 40 years old
- no puffy nipples pre-op
- began massaging entire breast area at 4 weeks post op, focusing mostly on harder tissues on either side of the areola, no scar tissue buildup noticed at areola incision points
- started massaging for 5min/each side/day, last few weeks I've doubled that to 10min/each side/day
- no scar tissue buildup at all at lower ribcage incision points
- started working out at the gym (first time in years) at 6 weeks post op, also started to play squash again
- started P90X exercise program at 9 weeks post op.

Is there anything I can do?  Will this resolve on it's own and is it normal for scar tissue to show up this many weeks later?  Why at areola incision points but not the others?

And the big question....could massaging actually be making this worse?

I can provide pics if necessary.  Thanks.

[Dr. Elliot Jacobs]

First -- the body only heals with scar tissue -- so you need it.  And there will be firm, sometimes thickened scar wherever an incision was made as well as under the skin wherever tissue was removed.  It is a mystery as to why the body makes more scar tissue in certain areas than others -- some of it may be due to the surgery itself, some to (perhaps) small amounts of pooled blood, and some we just don't know.

What you describe is not uncommon.  Massage can help -- and so can time.....so be patient.  Finally, if it persists for over 4-6 months, you might consider some steroid injections directly into the scar.  These should only be done by a doctor (your surgeon) or someone who is well versed in its use.

Dr Jacobs

[waves]

Thanks for the response Dr. Jacobs.  I feel a little more assured and will carry on massaging, crossing fingers and being patient until the 6 month mark before pursuing anything further if unresolved.

[Litlriki]

It's not uncommon to feel some scar build-up at the incision point around the areola, and from a timing perspective, this is the time when you'd expect to see thickening in that area.  I agree completely with Dr. Jacobs, that you should massage the area and wait.  I like to wait about 6 months before injecting the scar there, since there are some minor issues that can occur with injection of steroid into the scar, and since these usually resolve on their own. 

Good luck.

Rick Silverman

[DrPensler]

First I would talk with your surgeon. Second scarring occurs in 100 % of cases. The scarring increases with time typically maximizing at 4 weeks post op. The scaring settles down with time.Often deep resorbable sutures have been placed and they need to be resorbed by your body and swell as the body dissolves them. Pressure causes scars to mature more rapidly ( a good thing ).Massage is a form of pressure,also sometimes small amounts of steroid injected in the area is beneficial (only to be done by surgeon).
Jay Pensler,MD

[waves]

Drs. Silverman and Pensler,

Thank-you as well for your replies.  Some very good information in all of the responses and of course reassuring to know this is normal.  Especially as it doesn't look or feel that great right now.

I'll continue to massage and post again in a couple of months so others in the future have a longer term update.