Scar revision for hypertrophic scars

[Dghtx832]

Hello doctors, i had gynecomastia surgery and a donut mastopexy 6 months ago and was left with horrible scarring around my areolas. My doctor has scheduled me for a scar revision late in January and i'm very hopeful this time. They feel confident my scars can be made better looking. I was just wondering if there was a technique i can talk to my surgeon about. As in a different suture. I have read permanent sutures can help a scar heal nicer as it takes tension off the inscicion itself. Any suture techniques i can mention to him? I just really want to get this issue somewhat better looking as i am very sad about the appearance of my chest.

[Dr. Elliot Jacobs]

Your result is the reason that I virtually never perform a donut mastopexy.  The thickened scars are nature's way of reacting to the tension under which the wounds were closed and healing of wounds under tension frequently leads to thickened scars.

Many surgeons do not appreciate the extent to which chest skin can self-tighten once the underlying excess tissues have been adequately removed.  Thus a surgeon, when faced with potential excess skin, will attempt to tighten the skin at the same time with any of the available techniques -- and the circum-areolar technique is one of them.

The best chance of getting a better result with a scar revision would be with the use of a permanent suture under the skin, which reduces the tension on the wound closure.  Assuming it works, then you would be left with a palpable round suture at the edge of the areola just under the skin.  Give it one year and then the suture could potentially be removed.

Good luck!

Dr Jacobs

[Dghtx832]

Your result is the reason that I virtually never perform a donut mastopexy.  The thickened scars are nature's way of reacting to the tension under which the wounds were closed and healing of wounds under tension frequently leads to thickened scars.

Many surgeons do not appreciate the extent to which chest skin can self-tighten once the underlying excess tissues have been adequately removed.  Thus a surgeon, when faced with potential excess skin, will attempt to tighten the skin at the same time with any of the available techniques -- and the circum-areolar technique is one of them.

The best chance of getting a better result with a scar revision would be with the use of a permanent suture under the skin, which reduces the tension on the wound closure.  Assuming it works, then you would be left with a palpable round suture at the edge of the areola just under the skin.  Give it one year and then the suture could potentially be removed.

Good luck!

Dr Jacobs

Of course i don't expect you to know my outcome after the scar revision but do you believe that with a permanent suture my scars can be made somewhat more appealing? I know there will always be a scar but the revision could make it better, am i right?
My surgeon said that after 4 weeks of the scar revision he will start a thing called dermapinning or something like that to reduce risks of hypertrophic scarring? Is that good?
I workout a lot and i also wanted to know if doing exercises that stretch the chest can lead to the scars becoming hypertrophic as well. I do a lot of bench pressing and pullups, and well honestly almost every upper body weightlifting exercises pulls on the chest. How long should i refrain from weightlifting after the revision?

[Dr. Elliot Jacobs]

As I stated, your best chance at an improvement of your scars is with a scar revision using a permanent suture under the skin.  No one can predict how the results will turn out.

Best to speak to your surgeon about your other questions.

Dr Jacobs