SCAR MANAGEMENT FAQ's
for Double Incision Top Surgery
Almost every technique for top surgery involves cutting the skin, and often removing extra skin and these cuts make scars. Even plastic surgeons cannot do surgery without leaving scars.
As your plastic surgeon, there is much that I do DURING the actual surgery to minimize and improve the potential scars, and I do this for every patient.
What are those things?
Meticulous and careful handling of your skin where the scars will be (I don’t use harsh and heavy clamps, or temporary staples, or any sharp instruments near the skin border that will need to heal).
I make sure there is adequate and excellent blood flow throughout the healing skin by not taking away too much skin and fat, and not making the healing skin too “thin”.
When I sew the skin and nipple and areola back together I use multiple layers of sutures so that there will be strength not only on the very superficial level but on the deeper levels as well.
Below you can find my answers to frequently asked questions about scar management after top surgery (or any surgery that involves scars).
Question: When can I start scar management or treatment?
Answer: Everyone actually starts this right away by complying with the tape and bandages that I use during surgery.
Usually at 3 weeks the chest is healed enough to start a few very important techniques that will help:
Soften all your scars
Improve sensation (the way it feels)
Smooth out any bumpiness along the scars
When can I start scar management or treatment?
Question: What is scar management?
Answer: Each patient will have a customized program to help their body produce the best possible scars.
Every patient needs to massage the entire chest (gently at first) starting at 3 week’s time.
What is scar management?
Question: What do I massage and for how long?
Answer: You begin massaging with gentle circular motions at the top of the chest near the bony clavicle, and then move your way from the middle of the chest to the sides and from the top of the chest all the way down to the nipples and areolas and to the entire scars and below the scars. You want to spend about 5 minutes a day doing this. You can do it in the shower with a little bit of soap on your hands or with a little bit of lotion or oil that you like. The important thing is to DO IT. You will notice that you will get sensation back sooner, things will feel more “normal”, hurt less, and the swelling and bumpiness will dissipate.
What do I massage?
And for how long?
Question: What should I put on the scars? There are so many scar products, which one is the best? I read that Mederma is really good, is that true?
Answer: There are no great controlled studies that show that one product works definitively better than another. What has been shown is that massaging and taking notice of your scars does help. The good news is that the expensive scar gels are not better than any other lotion or oil. You should use what you like and what feels and smells good to you. Scars do tend to become dry and then itchy thus an oil or moisturizer works well. I like Bio Oil, but any oil, lotion or gel is fine.
What should I put on the scars themselves? There are so many scar products, which one is the best? I read that Mederma is
really good, is that true?
Question: What about taping with scar tape?
Answer: I recommend taping with silicone scar tape, or simple paper tape for about one quarter of my patients. Tape will help if your scars start to become raised (thickened) or start to spread (widen), in those patients I recommend scar tape. Generally, you want to leave the tape on at least 5 days, and shower and have activity with the tape on, and then change it. Changing the tape daily is usually too irritating for the skin.
What about taping with scar tape?
Question: I am allergic to a lot of bandages – can I still use the tape?
Answer: In those patients we try out a small area with paper tape (also called steric-strips) and that tends to be very well tolerated by all.
I am allergic to a lot of bandages – can I still use the tape?
Question: How long should I use tape for?
Answer: Generally, if you are seeing that your scars are looking worse and not better –you need to tape for at least 2 months, and then together we will reassess.
How long should I tape for?
Question: My scars are really itching, is that normal?
Answer: Yes! It’s a normal part of the healing process. Use a moisturizer if you are past the three week mark, and if they feel tender and seem really red, and feel “ropey” you may benefit from an injection of steroid into the scar to reduce the swelling.
My scars are really itching,
is that normal?
Question: Underneath the scars – deep beneath the surface, it feels really firm, is that normal?
Answer: Yes, you have scars that you can see on the skin, but there is also scar tissue underneath, and it feels firm. The best thing for improving this is time, and massage. After 6 weeks you can also do fascia release techniques.
Underneath the scars - deep beneath the surface, it feels really firm, is that normal?
Question: What is a spitting suture?
Answer: When the stitches start to dissolve, sometimes they cause inflammation and they can "spit" out of the skin causing redness and discharge. You may be able to see or to feel a little "pokey" stitch coming out of the skin. Often when this happens it looks like it is infected - it is just a normal process. What to do?
Clean area with hydrogen peroxide twice a day
Put Neosporin or Aquaphor on twice a day
Cover with a bandaid until it dissolves
If you can - you may snip the stitch. Usually this resolves in 1-2 weeks.
What is a spitting suture?