What Every Woman Should Know About Mastectomy Scars and Breast Reconstruction

Undergoing a mastectomy can be a life-changing decision for many women, often necessary for the treatment or prevention of breast cancer. Each year, tens of thousands of women face this surgery, which, while lifesaving, leaves both physical and emotional marks. 

Mastectomy scars are more than just physical reminders; they can carry significant psychological implications regarding body image and self-esteem. Fortunately, advances in medical science have brought various options for breast reconstruction, which allow women the chance to reclaim their body shape post-surgery. Below, we explore what every woman should know about mastectomy scars and the possibilities of breast reconstruction.

The Different Types of Mastectomy Procedures and What to Expect in Terms of Scarring

There are different forms of mastectomy, each of which varies in complexity and the extent of tissue removed. These factors influence both the immediate recovery and the long-term appearance of scars.

For instance, a simple or total mastectomy involves the removal of the entire breast, including the nipple, areola, and most of the overlying skin. This procedure is often recommended when the cancer is confined to one area that can be easily targeted. Scarring from this typically runs horizontally across the chest, slightly below where the breast used to be. The length and visibility of the scar depend on the surgical technique used and your body’s healing process.

In a modified radical mastectomy, the entire breast is removed along with some of the underarm lymph nodes. The scar usually extends from the removal site of the breast to under the arm, where lymph nodes are excised. This procedure is generally chosen if there is a need to examine or remove lymph nodes due to the spread of cancer.

Another procedure which is quite popular is skin-sparing mastectomy, in which most of the breast skin is preserved. This procedure allows for a more natural reconstruction outcome. The removal is typically through a smaller incision around the areola or under the breast, which can significantly minimize scarring. However, this option is usually suitable only if there is no cancer in the skin.

Similarly, nipple-sparing mastectomy preserves the nipple and areola along with the breast skin. This approach is ideal for cases where cancer is not near the nipple. The incisions might be made at the periphery of the areola or under the breast, maintaining the natural look of the breast post-reconstruction. Scarring is often minimal and hidden beneath the contours of the reconstructed breast.

What Factors Influence the Scarring?

One primary factor is the surgical method itself. Different types of mastectomies can lead to different scarring outcomes, as we discussed above, which means the incisions vary in size and location. Techniques that preserve more skin, such as skin-sparing and nipple-sparing mastectomies, typically result in less conspicuous scars compared to traditional mastectomy procedures. The skill and experience of your surgeon also play a critical role; meticulous suturing and careful handling of tissue can minimize scar width and prominence.

Your genetic predisposition is another significant factor. Some people are naturally more prone to keloids or hypertrophic scars, which are thick, raised scars that grow beyond the boundaries of the original incisions. Apart from this, your age and skin type also play a role. Older skin tends to be less elastic and may not heal as quickly as younger skin, potentially leading to more pronounced scarring. Additionally, your skin color influences scar visibility; individuals with darker skin tones are more likely to develop keloids or hypertrophic scars.

Nutritional status and overall health also impact how well your body can heal after surgery. Proper nutrition, including adequate protein intake and vitamins such as C and E, supports wound healing. Conditions like diabetes or vascular diseases can impair circulation, complicating the healing process and potentially worsening scarring.

How to Manage and Heal Scars After Your Mastectomy 

After undergoing a mastectomy, managing and healing your scars is an essential part of recovery. Here are some tips to follow immediately after surgery:

• Wound Care: Initially, proper wound care is crucial to prevent infection and promote healing. We highly recommend following your surgeon’s instructions for cleaning the wound and changing dressings. Make sure to keep the wound dry and clean, as it ensures that the initial healing phase goes smoothly. 

• Silicone Gel Sheets and Gels: Once your surgeon approves, you might begin using silicone gel sheets or gels. These products are widely recommended because they help to hydrate the scar tissue and reduce the production of excess collagen, which can lead to raised scars. According to a report, silicone gel sheets and gels are effective in preventing hypertrophic scars and keloids, which are common concerns post-mastectomy.

• Hydration and Nutrition: Keeping your body well-hydrated and nourished is crucial for healing. Water is essential for maintaining skin elasticity and aiding in the healing process, while a balanced diet rich in vitamins such as Vitamin C and E supports skin health and scar healing. 

• Monitoring for Complications: It’s important to keep an eye on your scar for any signs of complications such as increased redness, swelling, warmth, or drainage, which could indicate an infection. Early detection and treatment are key to preventing further issues.

• Avoiding Sun Exposure: Protecting your scar from the sun is critical during the healing process. UV rays can cause scars to become darker and more noticeable. Applying a broad-spectrum sunscreen with an SPF of 30 or higher over the scar once it's sufficiently healed can prevent these changes.

• Managing Pain and Itching: Scars can be itchy and sometimes painful. Over-the-counter pain relievers and topical treatments like hydrocortisone cream can alleviate discomfort. Always consult with your healthcare provider before applying any new product on your scar.

Long-Term Scar Management

Over time, the focus shifts from immediate healing to improving the appearance and condition of your scars. 

For that, we recommend continuing the use of silicone sheets or gels. As we discussed above, these products work by hydrating the scar and reducing the collagen build-up typically responsible for raised scars. In some cases, laser therapy can be an effective treatment for scars that have matured but remain prominent or discolored.  Laser treatments can reduce the redness of scars, smooth out the texture, and flatten raised scars. 

If you have hypertrophic scars or keloids that do not respond to silicone products or laser therapy, corticosteroid injections may be beneficial. These injections can help flatten and soften thick scars. Similarly, if you're self-conscious about the visibility of your scars, cosmetic camouflage can be an option. Special makeup and tattooing designed for scar coverage can make scars blend more with your natural skin tone. 

Regardless of the appearance, it is critical to protect your scars from sun exposure remains important even years after surgery. UV rays can darken scars, making them more noticeable. Using a high-SPF sunscreen specifically designed for sensitive skin can protect your scars and aid in their long-term management.

We also recommend regular check-ups with your healthcare provider to monitor the condition of your scars. Your doctor can recommend updates to your treatment plan based on how your scars mature and your overall skin health.

Remember, each person's experience with scarring is unique, and what works for one may not work for another. It’s important to tailor your scar management practices to your specific needs and the characteristics of your scars. 

What Are Some Breast Reconstruction Options to Explore?

Those who undergo mastectomy also have the option to consider breast reconstruction, which is a surgical procedure to restore the shape and look of your breast after removal due to cancer or other diseases. There are several different forms of this procedure available. 

• Implant-Based Reconstruction: This is one of the most common forms of breast reconstruction. It involves placing a breast implant under the skin or muscle after mastectomy. 

• Autologous or Flap Reconstruction: Flap reconstruction uses tissue from another part of your body, such as the abdomen, back, thighs, or buttocks, to create a new breast mound. The DIEP flap (deep inferior epigastric perforator), which uses fat, skin, and blood vessels from the abdomen, is a popular choice as it spares muscle tissue and leads to less abdominal weakness post-surgery. 

• Combination Reconstruction: Some women may opt for a combination of both techniques—using an implant along with autologous tissue. This method can be advantageous for those who do not have enough tissue to achieve the desired breast size or for whom implant alone may not offer the most natural result.

• Nipple Reconstruction: After the initial reconstruction of the breast mound, nipple and areola reconstruction can be performed. This often involves tattooing to create a natural-looking nipple and areola, and sometimes a small flap of tissue to create a nipple-like projection. 

• Fat Grafting: An adjunct technique often used in breast reconstruction is fat grafting. It involves liposuction to remove fat from one part of your body, which is then processed and injected into the breast area to improve the shape, smoothness, and contour. 

Picking the right kind of breast reconstruction for yourself or a loved one involves considering several factors, including health status, body shape, previous surgeries, lifestyle, and personal preferences. It is best to discuss these options with a plastic surgeon who specializes in breast reconstruction and can provide you with tailored advice and information.

Questions to Ask Your Surgeon

If you are preparing for a mastectomy and considering breast reconstruction, it’s crucial to engage in a thorough discussion with your surgeon to understand the process and set realistic expectations. You might want to begin by inquiring about your surgeon's qualifications, experience, and specialization in breast surgery.

Discuss the types of mastectomy and reconstruction options available, including the pros and cons of each. Ask about the stages of surgery, the materials used, and what each procedure entails. This will help you understand what to expect and make an informed decision about which option might be best for you.

It is also a good idea to request to see before and after photos of other patients. This visual reference can provide context for what is achievable. Additionally, discuss potential risks and complications, how common they are, and the measures taken to minimize these risks. Also inquire about the expected recovery period, pain management strategies, and care requirements. Ask your doctor about the potential physical limitations and long-term impacts on both your body and mental health. 

Also, inquire about available emotional support resources, such as counseling or support groups. Finally, clarify the cost of the surgery, including what is covered by insurance and any potential out-of-pocket expenses. This can help you plan accordingly and avoid surprises.

If all this seems overwhelming to you, remember that you are not alone. We, at the Bass Cancer Center are dedicated to providing support and expert care through every step of your mastectomy and breast reconstruction journey. Our team specializes in the latest surgical techniques and offers comprehensive care to help you make informed decisions and manage your recovery with confidence. Contact us today to explore your options and discover how we can assist you in regaining your confidence and living your life to the fullest.