Scars, are they Worth the Trade-off?

Breast reshaping and lifting requires tightening of the skin envelope in all dimensions. The nipple and areola need to be moved up and made proportional to the new breast size. A certain scar pattern results. There is no way to achieve tightening and a lift effect without scars.  Currently there is no technology, laser, ultrasound, radiofrequency, or any “internal-lift” technique that tightens and/or lifts breast tissue safely and effectively. If there were ways to do these surgeries without external scars, we would all be having ours done that way.

The majority of people accept the location of the areolar scar and breast fold scar, as they hide in natural breast creases and contours. The vertical scar is the source of hesitation, as it traverses the lower half of the breast in a conspicuous manner.  Ironically, and for reasons unknown, the vertical limb scar almost always heals the best. This scar fades and blends with time and has the best overall quality. Even in patients with a history of poor scarring, this scar limb is rarely prone to keloids (scars that grow larger than the incision) or hypertrophic scars (red and raised scars). This scar is also the result of a very powerful deeper breast lift maneuver, so the benefits are definitely worth it.           

The scars hide in normal bras, swimsuits, and clothing. They are visible up close by the individual and their family. They fade and blend into surrounding skin over years and often times look no different or even better than a stretch mark. Across a room (like in a spa setting), they go unnoticed. Many women also possess this scar pattern, so it is quite common, especially in our region where many women opt for breast surgery.

Not all women are so lucky to have youthful, well-shaped, perky, and symmetric breasts right from puberty. Breasts come in all different shapes and sizes with asymmetry and degrees of sagging being the norm. These women consider augmentation mastopexy surgery earlier rather than later, before childbearing, to improve self-confidence and their ability to wear clothes and swimwear that fit well and look attractive. Even in this age group, augmentation mastopexy and its associated scarring are worthwhile endeavors with life-changing results. These young women go on to interact with friends, date, and enjoy social situations with more ease, confidence, and comfort than before. Asymmetries in breast volume, breast position, and nipple position are much harder to hide in clothes and swimsuits than scars.

In Las Vegas we have a subset of patients in the entertainment industry, who are exposed at work. These patients commonly undergo augmentation mastopexy surgery, and feel comfortable and attractive returning to work with their new breast contours. The scars are an afterthought, they conceal in dim light and makeup, and these women continue to be successful in their endeavors.

Scars are permanent and everyone heals differently, so no guarantees can be made on the final scar quality. Keloid scars, hypertrophic scars, dark scars, light scars, and wide scars are always a possibility depending on your inherent healing ability, irrespective of the perfect hairline closure performed by Dr. Brown.

So the answer is YES, they are worth the trade-off. Patients want their breasts as naturally high and tight as possible. Tissues relax and stretch over time; implants respond to gravity and drop and settle. This dictates skin tightening in all dimensions. Surgery involves incisions, and scars are the trade-off…unfortunately there’s no magic.

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