hypertrophic scar (areola) ?

[conan]

Hello Doctors, i had surgery about 6 weeks ago. Overall I'm pleased (so far) with the results.

I do have one concern, i seemed to have developed what may be a hypertrophic scar on my lower left areola (where the doctor made the peri-areolar incision).

I'm assuming its a hypertrophic scar, u cant really see the scar but its causing the bottom of my areola to stick out abit (giving it a puffy nipple appearance at the bottom half)

The incision itself looks great, so I'm assuming its internal scar tissue that's causing the areola to stick out?

A few questions that i have are.
-how common is this?
-will it usually resolve on its own?
-how effective are cortisone shots with this type of scar?
-what are your thoughts on applying silicone gel to the scar in the meantime?

Any input would be greatly appreciated, thanks.

[Dr. Elliot Jacobs]

It is too early in the healing process for you to have a hypertrophic scar.  what you probably have is scar tissue plus swelling beneath the skin.  This is not uncommon at 6 weeks.

Would very strongly recommend relaxing and allowing the wounds to heal and settle down.  You should visit your surgeon for further reassurance.

In several months, take another look at the scar.  If there is still thickening in the scar itself above the level of the surrounding skin (which is a true hypertrophic scar), then usually some cortisone can help significantly.  But at 6 weeks -- relax and don't worry about it.

Dr Jacobs

[DrPensler]

Maximal Scarring occurs at around four to six weeks postoperative. So it is still very,very early for you. Also I commonly evert the edges of the areola incision to minimize ( but not eliminate) the risk of retraction postoperatively. If your incision is narrow but the area of the incision is raised which may be what you are describing you are describing an enverted incision which is good .

[conan]

Thanks Doctors, it makes sense now.

I saw my Doctor 2 weeks post-op and everything was fine. I also have a 3 month post-op app. booked as well.

I know im thinking premature here, but will silicone gel (cream) or silicone sheets do anything to minimize internal scarring or can it be used as a preventative measure to minimize the occurrence of a hypertrophic scar? Thanks..
 

[Dr. Elliot Jacobs]

Silicone gel sheets have no effect whatsoever on internal scar tissue.  they only work on surface scars.

And since hypertrophic scars in gyne surgery are rare, I do not recommend them routinely after surgery -- unless I see a need for them.

Dr Jacobs

[conan]

Ok thank you. Now what about a compression vest for internal scarring (mainly under areola) is there any benefit to wearing that at this point ? (just over six weeks post-op)

Doctor told me i could stop wearing it after 3 weeks if i wanted.

I'm still wearing it at work b/c of my physical job, and also when im sleeping.

Does the pressure that the vest provides give me any benefit at this point to the scars?

thanks.

[Dr. Elliot Jacobs]

It has been my experience that wearing a really snug compression garment for at least four weeks is beneficial for most patients.  If you can wear it longer, it can only help -- it cannot hurt.

The pressure is mainly helpful to reduce swelling -- scar tissue beneath the skin really can't be managed by pressure garments.

Dr Jacobs