Will my Incision Site Scars Be Much Worse After a Breast Implant Revision?

As others have stated, you still have some softening, settling, and swelling reduction to occur over the next several months. But even if you are convinced that NOW is the time to re-operate, there are a couple of things to consider:

     First, your scar has not completely matured and re-operating through the same incision could contribute to slightly more visible scarring (even though the old scar is removed and a "new" scar is created in the same location). This is because of the residual edema and induration (the firmness you feel around your scar) that makes suturing more difficult and healing perhaps slightly more problematic. Waiting 6 months allows your scars to soften and mature enough so that excising the old scar can yield as good a result as you now have.

     Secondly, a 50 cc change may seem like a reasonable decrease, but 50 cc is the same volume as 3 tablespoons and 1 teaspoon of liquid. Put that amount in a glass and see if you think that much less over an entire breast's volume will really be a noticeable drop. To look at this another way, 50cc is roughly equivalent to one-fifth of a cup size. Do you really want to undergo the (slight) risks, the not-so-slight costs, and your concerns about the scar for a change that will likely not even be visible (except in your mind's eye!)?

Finally, a new incision makes no sense! You and your surgeon selected what you both felt was the "best" choice for your surgery, though other surgeons and patients may differ. Why add a second pair of incisions and scars?

Thank you for your question. Going through the same incision is a great idea so you are not creating a new scar.  Post-operatively, breast incisions can be managed using a multimodal approach:1) Scar massage - starting as soon as the surgical dressings come off and the incisions are sealed2) Silicone sheets or scar gels for about six months to year3) Embrace - a tension reducing dressing for the first 2 months4) Fractionated lasers to help blend the scar into the background - done as a series, starting about 4 weeks after surgery and repeated every four weeks for six months.5) Sunscreen to prevent the scars from darkening

Hello! Thank you for the question!  The typical incision used for breast augmentation are: inframammary (in the fold beneath your breast), periareolar (at the border of the areola), axillary (within the armpit crease), and TUBA (through the umbilicus). Incision placement will do a lot with your preference, surgeon comfort level with that approach, and the type of implant - silicone implants will be difficult to place within certain access incisions. Breast augmentation scars are well concealed and are very discrete. They should not be visible within clothing, and likely hidden without clothing. If your concern is the visibility without garments, you should consider remote access incisions such as in the armpit. However, these other incisions heal very well on the breast and often times inconspicuous.  I do not expect your incisions to be any worse, in fact, if the previous scar is removed, it may even be better.  It is common for scars to fully mature for up to a year. In the meantime, there are a few things that may help to ameliorate your incision/scar. The most proven (as well as cheapest) modality is simple scar massage. Applying pressure and massaging the well-healed scar has been shown to improve the appearance as it breaks up the scar tissue, hopefully producing the finest scar as possible. Other things that have been shown to add some benefit, albeit controversial, are silicone sheets, hydration, and topical steroids. In addition, avoidance of direct sunlight to the incision will significantly help the appearance as they tend to discolor with UV light during the healing process. If unsightly scars are still present after approximately a year's time, other things that your surgeon may consider are intralesional steroid injections, laser, or just surgical revision of the scar itself.Consult with a plastic surgeon your goals, concerns, and expectations. Certainly incisions should be considered, but should not limit your overall result by hindering visualization and access to your surgeon, and what produces the best results in his/her hands.Hope that this helps! Best wishes!

When a new incision is made through an existing scar, it usually heals just as well if not better. You are not planning to make much of a size change though and it is very early in your recovery so I would advise waiting a few months more and then make sure it is what you want.

Waiting a few more months before making your decision will possibly save you some worrying.  Your breast tissue may be swollen still and the implants may settle more.  If you do plan to revise the implant size, stay with the same incision site.  Going thru the armpit or thru the belly button may cause the breasts to be uneven.  Nipple placement is the most accurate.  If you already have scarring, it will not be too much more noticabe depending on the surgeon, smoking and tanning. 

When performing a revision and going through the old scar, the old scar is usually excised and then closed at the end of the procedure. It should heal as well as it did after the first one.

If your scars look good right now, using the same site for a new incision makes sense.

However, it may be too early to replace 300cc implants for 250cc implants. Give it at least a few more months to allow for tissue swelling to resolve and for the implants to settle.

You don't have much to lose by waiting but much to save if you don't need another surgery!

 

Which incision to use for repeat breast implant procedure

Regarding: "Will my Incision Site Scars Be Much Worse After a Breast Implant Revision?
I had a breast augmentation about 2 months ago with 300cc salines and they are too big so I am planning on having a revision with 250 cc silicone. I went through the aereola and it has been healing very well. I was wondering if I went through that same incision site again, would the scar be alot worse? I reallly do not want my implants to be noticable. Would I be better off going with the transaxillary incision? Does that incision heal well and is it noticable?"

Before embarking on yet another operation, you should be sure that you understand what is involved here and you accept the size of the lower volume silicone implants.

I think you should wait at least 6 months for all surgical inflammation to subside before considering a re-operation. But, already having a periareolar ("around the nipple") scar, you already have the scar which offers the best visibility and I would re-use that scar. The scar should NOT look worse after a re-operation since the old scar is actually removed during the procedure giving you a fresh scar.

Dr. Peter Aldea 

At 2 months, you are still in the healing phase and the implants have not fully settled. I recommend women wait at least 6 months before deciding on changing the size of their implants, whether to go smaller or bigger. There is a difference in how the implants look at two months and six months, just as there is a difference between how they look now versus at just one week.

If you really do want to change your implants, using the same incision is perfectly fine, especially since you are healing well. The scar will not be worse, especially since you are going to a smaller size and thus putting even less tension on the incision. I wound not recommend going through a trans axillary incision at this point because you already have an incision on the breast, which is the only advantage trans axillary incisions offer over periareolar and infra-mammary incisions.

Hope that helps and good luck!

Hopefully you are getting the message from every experienced plastic surgeon here that 2 months is not showing you the final result.  It takes 6 months to get there and you will be smaller then than you are now. 

Also, only going down 50cc may not even show and in general closer to 100 ccs is needed to go up or down to any significant degree.  Using the same incision would be best also if you do eventually do a revision.