Friday, June 14, 2024

How People of Color Can Prevent and Treat Breast Augmentation Scarring

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Making the decision to undergo breast augmentation surgery is not one that should be taken lightly. Spending adequate time choosing the right surgeon and understanding the costs involved are both very important—as is inquiring about the short and long-term recovery process. And for people of color in specific, this includes scarring.

But let’s be clear: regardless of skin tone, any type of surgical incision will create a scar. However, for melanated skin, there’s a greater chance of experiencing post-inflammatory hyperpigmentation as a result, along with a raised scar.

“Darker skin has a higher risk of developing thicker scars, or keloid scars—hard, smooth scar tissue that grows at the site of the incision—than lighter skin,” explains Birmingham, AL dermatologist Corey Hartman, MD.

Like any other cosmetic procedure, there are a variety of reasons why people may choose to get breast augmentation surgery. Being unsatisfied with the size or shape of one’s breasts is a common motivation, but there are also situations where a person may want to remedy asymmetry or a deformity like tuberous breasts, for example.

In any of these scenarios, being left with an obvious scar may not be ideal—especially if you prefer discreet results, which, according to the American Society of Plastic Surgeons’ 2023 trends report, is quickly becoming the norm. Surgeons are noticing patient’s desire to abandon the exaggerated look that was popular in the ‘90s and 2010s, in exchange for a more conservative approach. “Women are more interested in looking proportionate and natural, with breasts that have elegant cleavage, a gentle slope, upturned nipples, and fullness in the lower aspect of the breasts,” explains New York plastic surgeon Barry Weintraub, MD.

With this in mind, it’s important for people of color who want to undergo breast augmentation to understand how to prevent visible scarring in the first place, as well as the best treatment options post-procedure to ensure optimal results.

How to Prevent Visible Scarring from Breast Augmentation

As previously mentioned, any type of incision on the body will lead to the formation of a scar—but there are ways to conceal it or minimize the appearance. However, if your skin tends to form keloid scars, make sure to be transparent with your doctor to ensure realistic expectations for your post-surgical results. “If a person is prone to keloids, then any surgery including breast augmentation can lead to the formation of keloids,” says Dr. Hartman.

Choosing the Right Incision Site

Choosing the correct incision site can make a world of difference for people of color looking to undergo breast augmentation. Because while some approaches can leave scarring around the breast, other techniques are much more discreet.

Traditionally, both saline and silicone breast implants have been inserted either through a periareolar (around the areola) or an inframammary incision (under the breast crease). Transaxillary (under the armpit), as well as transumbilical (through the belly button) are options as well, but have traditionally only been performed using saline implants, due to the fact that these devices are filled after insertion. Silicone implants, on the other hand, are pre-filled, typically requiring a larger incision.

Before undergoing breast augmentation surgery, it’s recommended that you speak with your plastic surgeon to ensure you’re fully informed on how the incision site you choose will impact the look of your final results. However, for people of color, both Dr. Hartman, along with New York dermatologist Michelle Henry, MD generally suggest going with the transaxillary approach.

“It avoids any visible scarring on the breast itself,” explains Dr. Henry.

While this technique has historically only been performed using saline implants, more and more doctors have started to offer it with silicone devices in recent years. However, Dr. Weintraub abandoned both periareolar and inframammary incisions over 15 years ago, in favor of the transaxillary approach—exclusively using Mentor MemoryGel Breast Implants. The combination of Mentor’s proprietary highly cohesive gel, implant shell design, and precision-fill ratio results in an implant that is both stable and provides a natural feel,” says Alenka Brzulja, worldwide president at Mentor.

Dr. Weintraub’s reasoning behind using the transaxillary technique is to ensure his patients are left with the most natural-looking results possible. “The periareolar approach leaves patients with easily seen scars around the lower circumference of the nipple-areola complex, and the inframammary approach places the scars under the breast, which is again easily seen,” he explains. “By contrast, the axillary incision is only approximately one to one-and-a-half inches, located in one of the natural armpit creases. If you were staring straight at breasts augmented with this approach, you would not see any signs that the patient had undergone surgery.”

Furthermore, as implants begin to settle and find their natural placement, known as the “drop and fluff” phase, both inframammary and periareolar scars can become more pronounced due to their placement. “Because the breast has weight, these scars can widen and become unsightly, whereas incisions placed in the axilla do not share this problem,” explains Dr. Weintraub. “[The incision in this area] remains fine and narrow.”

Dr. Henry also points out that skin around the breast crease and areola are at great risk for tension, which can result in poor healing. “Skin in the armpit region tends to have thicker and more sebaceous glands,” she mentions, which may benefit patients, as wounds tend to heal more quickly in moist environments.

Aesthetic reasons aside, the transaxillary approach also prevents patients from losing breast and/or nipple sensation. “Both [the periareolar and inframammary] approaches require violating the breast or violating the chest due to the dissection route required for implant placement,” explains Dr. Weintraub. “This dissection can potentially jeopardize nerves and sensation to the nipples, as well as impacting the ability to breastfeed. There is no interference with sensation or breastfeeding [with the transaxillary incision].

Understanding Your Doctor’s Suturing Technique

The technique your doctor uses to insert your breast implants, along with how they close the incision, will have a definite impact on how the skin heals, and thus the appearance of the scar.

“It is crucial to choose a plastic surgeon experienced in working with skin of color, as they can employ techniques that are tailored to reduce the risk of scarring and keloid formation,” Dr. Henry shares. “Precise and meticulous suturing techniques, as well as using appropriate suture materials, can help minimize tension on the incision and optimize wound healing,”

Dr. Hartman advises patients to inquire about previous outcomes and ask to see before and after pictures to get an idea of what your scar may look like post-procedure. When seeking out the right surgeon, it’s important to trust your gut and ensure you feel comfortable with the results. So if you don’t like what you’re seeing, look elsewhere.

In Dr. Weintraub’s practice, he works with the patient the morning of surgery to decide on the exact incision site, which is around one to one-and-a-half inches long, and is always placed in one of the natural creases of the armpit to minimize visibility.

During the actual procedure itself, once he makes the incision, he creates a pocket behind the pectoralis major muscle, and carefully inserts the implant.

After the procedure is complete, patients will wake up in a surgical bra that remains on for three days, then it is removed in-office.

“The patient will then see their new breasts for the first time,” Dr. Weintraub shares. “They will then go home, shower, and they can then wear a soft, zip-up sports bra. After approximately two weeks, the patient is instructed about very important self-massage techniques that aid in healing and prevention of capsular contracture. It is at this time that the patient can resume normal activity and can go back to exercising and living life as before the surgery.”

In most cases, the wound should also be closed after the two-week mark, according to Dr. Hartman. And if necessary, scar treatment can begin, whether at-home or in-office. At this point, be sure to speak with your doctor to develop a unique plan that suits your needs.

How to Treat Visible Scarring from Breast Augmentation

The formation of a scar is inevitable any time an incision is made on the skin. Luckily, there are a number of professional and at-home treatment options to help reduce the appearance of scars from breast augmentation surgery.

At-Home Treatment Options for Scarring

If patients are unhappy with their scars, most surgeons will typically suggest trying at-home treatments before scheduling any in-office procedures.

“The first line of defense is a scar gel, which should be applied as soon as the wound is fully sealed in order to create surface tension, thereby keeping a scar flat and contained,” Dr Weintraub shares. “It is recommended to be applied twice per day and every patient who has incisions should use it.” He also recommends applying a medical-grade sunscreen, like Alastin’s SilkSHIELD All Mineral Sunscreen SPF 30 ($62), to the area on a daily basis. “In addition to helping to prevent scars from becoming hypertrophic, it guards against hyperpigmentation,” he says. 

In addition to these options Dr. Hartman also recommends using Bio-Oil ($16) for sensitive skin. “It is an all-natural product that uses natural plant oils, vitamins, plant extracts, essential oils, and anti-inflammatory and antioxidant ingredients,” he says. 

Regardless of which option you may choose, it’s always important to keep in mind that reducing the appearance of scars will take time—so patience is key. “It may take several weeks to months to notice results, particularly for older scars,” says Dr. Henry “It is important to follow the instructions provided with these products and consult with a healthcare professional if there are any concerns or questions.”

In-Office Treatment Options for Scarring

According to Dr. Henry, there are a plethora of options to choose from if your doctor decides professional treatments are the best path forward. However, the first step is to always ensure whoever you’re working with has extensive experience working with melanated skin to prevent worsening of any hyperpigmentation.

“In-office treatment options for improving the appearance of scars in skin of color may include laser treatments, such as fractional laser resurfacing or vascular lasers; chemical peels, or microneedling,” Dr. Henry shares. “These treatments aim to promote collagen remodeling, improve texture, and reduce the visibility of scars.”

Should a keloid scar form, Dr. Weinstraub’s suggests injectables. “The best treatment is direct injection with a low-dose Kenalog treatment—a commonly used steroid to decrease the inflammatory response and thereby soften, narrow, and flatten the scar.”

The number of treatments needed for desired results will vary from patient-to-patient, but on average, it could take several weeks or months. Pricing will also vary based on the type of treatment needed, and the location of the doctor. It’s also important to note that since these procedures are typically classified as cosmetic, they may not always be covered by insurance. However, you should always check with your provider to understand your options.

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