How to prevent hypertrophic scar

I am looking into getting breast augmentation. I have a history of hypertrophic scars. My first cesarean left me with a Hypertrophic scar. During my second cesarean my obstetrician removed to raised scar and used individual stiches that were removed earlier then normal (5days) and lots of steristrips applied. This time I never got a raised scar and healed perfectly. So my question is : Where is the best place for incision and what stich style appropriate to prevent hypertrophic scars in a breast augmentation?

funsun September 7th, 2016 QLD

  • Answer
     Robert Drielsma

    Robert Drielsma

    191 answers

    Plastic Surgeon
    New South Wales, Australia

    Every surgical procedure results in a scar and our aim is to achieve a scar that fades dramatically over time.  Breast augmentation with an incision under the breasts means that the scar can be hidden in the crease under your breast.  I don’t use external sutures for breast augmentation.  The very small incision is closed internal sutures and surgical tape that remains in place for a week.  Tape is then changed every few days for the next few months.  Once your wound is healed you can also use silicone gel strips and cream to help minimise the appearance of the scar.    Its important to note that scars take around 18 months to go through their maturation phase and during that time the scars can appear red and raised before typically fading.
  • Answer
    Dr. Raymond Goh

    Raymond Goh

    123 answers

    Plastic Surgeon
    Queensland, Australia

    Hi there Funsun.
    Scarring post any elective surgical procedure is determined in general by two categories of factors:1. Patient factors: genetic predisposition to adverse scarring (keloid or hypertrophic). This is often related to racial predisposition to adverse scarring. Other patient factors include smoking and general healing ability.2. Surgical factors: these include tissue handling and the way the wound was closed and supported. 
    If a patient was prone to adverse scarring, then all measures to prevent this from occurring are employed. These can include but not limited to: internal sutures to take the tension away from the skin surface, skin taping for additional support, and topical creams and gels. Despite all measures, some patients will still have a scar that is less than ideal. You do however need to give scars time to mature and fade. 
    The location of the incision (inframammary crease, around the nipple areola, or in the axilla) should not determine whether you are going to get a better scar or not. 
    I hope this is of help. 
    All the very best.
    Dr Ray GohValley Plastic Surgery