Hypertrophic or keloid scars can occur with any surgical episode, and the standard treatment protocols of pressure dressing, silicon gels, and/or local corticos-teroid injections should be employed as necessary. Most scars respond to conservative treatment. Persistent reddish or dark scars can improve by pulsed ruby laser therapy. Resistant keloid scarring with significant symptoms (pain, irritation, pruritis) may occasionally require reexcision and brachytherapy (iridium threads). It is rare to see scar hypertrophy of the vertical limb after breast reduction; when it does occur, it is usually at the inferior pole of the vertical scar if it crosses the inframammary fold (IMF). In fact, the low rate of vertical scar hypertrophy is one of the major advantages of vertical scar techniques; they bypass many of the difficulties of the inverted T scar techniques.
Wide or malpositioned scars more frequently occur at the base of the vertical scar. Using a purse-string suture at this level during initial surgery is a good option for shortening the vertical wound and for keeping the scar above the IMF; however, it may still result in a wide scar with persistent wrinkles. Such scars are usually easily corrected by reexcision and meticulous closure (Fig. 14.1). The vertical scar is more difficult to correct when it crosses the IMF. In this case, the scar can be elevated by a crescentic excision that incorporates the bottom of the wound into the IMF; this is in conjunction with liposuction on either side of the scar to avoid new dog ears. These simple corrections are amenable to local anesthesia. The wise surgeon should make the patient aware of the need for occasional "tidy-up" procedures at the initial consultation, especially in the case of large breasts. Taping of the scar postoperatively may reduce problems significantly. Correction is ideally performed 3 months after the initial surgery in order to allow wound healing and skin retraction to take place.
Was this article helpful?