LAM FACIAL PLASTICS

Hello,

I had a breast reduction surgery in 2008 and I developed keloids. Following my surgery, I was happy with the scar formation and I was not diligent at all with scar treatment (massage, silicone sheeting). I also had cyclical breast swelling with my menstrual cycles (my PS said that this may have been a possible cause). I developed the keloids so slowly and did not ything for at home treatment until 2011. I have gone to the surgeon who did the reduction and he suggested excision with kenalog injections but he was not confident that the scars will not re-occur. I have a dermatological (laser) consult booked, however, I have already been told by a dermatologist that there is nothing she can do.

My current scars are darker than my skin, shiny, raised and do extend beyond the borders of the original incision but are not bubbly like cauliflower or bubblegum...and as such, everyone who has seen them describes tham as keloids, hypertrophic or something in between.

I was considering excision, kenalog injections, silicone sheeting and compression garments. I figure that since I was not diligent the first time around (because I had no idea wht a keloid was and the scars I had were fine-looking, until later on of course) and I plan to be this time around, I stand a chance of improvement? I am not unrealistically looking for a complete scar removal. I understand that at best, I will have a scar in place of the first one. I was just hoping for a smaller, less unsightly one.

What do you think I shoudl do in this case? I have heard many good thing about the efficacy of radiation but the scar is right on my breasts, so it seems unlikely that this will work for me.

I am just plain hopeless right now. I work in social sciences research so I have access to many databases through my university and I have read countless publications and considered many options but I could use some advice.

if they are hypertrophic then steroids should be sufficient if they recur. if they are keloids, which the way you describe them does not sound that to be the case, then steroids will in my experience be insufficient. as far as radiation, remember if you go that route it has to be done within 24 hours of excision o/w it is not helpful. if you need to know about the risks of radiation near the breast, you should ask a radiation oncologist who would perform the procedure.
best,
s.

Thank you for the quick response. What is your experience with excision? I am debating excision because of terrifying anectodal internet evidence that they come back larger. If not for this fear, I'd absolutely consider excision combined with either steroids/radiation, silicone sheeting and compression garment. I will not be upset if they simply come back (less severe or as severe) but "worse" is a very scary risk to take. the scar is shopes like a "sour soother" candy around my nipple and down to the bottom of my breast but the long scar under my breast is not a "keloid", its simply a dark thick scar, which I am happy with. I am definetely trying to contact a radiologist.

if they are keloids, then yes they can come back much bigger. that is why you need radiation AFTER timed excision. if you they are hypertrophic scars, surgery should manage them. that is why diagnosis is so important. btw, it is NOT a radiologist (someone who reads X-rays and CTs) but a radiation oncologist, someone who administers radiation. totally different.

Thanks again. I saw a dermatologist yesterday who is recommending some laser treatments in conjuction with kenalog injections. He believes my scars are keloids because they extend far beyond the borders of the incision sites but are almost completely flat. In fact, he said he may not even do the injections, that it is up to me depending on how I feel after the laser. The laser he is using is "vasculight" and targets pigment, reducing redness and softening tissue.

I am having a dilemma. The dermatologist said "no way" do not excise the scar, it will come back larger. However, I haven't read a lot about laser on keloids. Have you heard of or seen any improvement of keloids with laser? Everything I read about keloids indicates that they are "incurable" but I haven't read much about "improvement" and I am merely looking for improvement in colour - I'd like them lightened. They don't protrude much at all.

Just to let you know. He recommended vasculight laser. (3 treatments, 2 months apart each with at home kelo cote and lustra cream). I haven't found much about the efficacy of vascular lasers on keloids so I don't know HOW this works and that is what bothers me. He seemed very very confident and optimistic but I am afraid of things like permanent darkening. All I want is fading as the scars are flat. Do you have experience with this laser?

to be honest, if this is truly a keloid then a laser is useless and perhaps can make it grow bigger. my feeling is only quality surgery combined with timed quality radiation has an exponentially better chance at fixing this situation. without radiation, then yes surgery can make this thing explode. that is why timed radiation is the key.
best,
s.