Scar Tissue Formation - Breast

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Surgeries such as a lumpectomy and mastectomy can save your life by removing cancer from your breast. But surgery requires an incision and incisions leave scars behind. 

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That’s because scars are a natural part of the healing process after a skin injury. 

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Understanding why scars form and how complications after surgery can impact the healing process will help you best manage your recovery. 

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Why do scars form?

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Scars are what the body makes to heal a wound, whether it’s from a small cut on your hand or a big surgery. 

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When a wound goes deep into the second layer of skin, known as the dermis, cells in your body respond by making a protein called collagen. Collagen fibers support the structure of skin, muscles, and more in the body. As your body repairs itself, collagen replaces the injured skin. The collagen patch is always visible as a scar. 

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As people age, collagen levels typically decrease, leading to wrinkles, joint stiffness, and more. Smoking cigarettes or too much time in the sun are also known to damage collagen. These and other factors — such as your genes and skin color, the location and depth of the wound, and medications you take — all impact how your skin heals. 

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Scarring after mastectomy and lumpectomy

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If you’re having surgery to remove breast cancer or breast reconstruction, you’ll have scarring, explains Joseph Guenther, MD, a surgical oncologist and clinical director of the Breast Center at St. Elizabeth Healthcare in Kentucky. 

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Surgeons will typically “try hard to place scars in either hidden or hard-to-see areas, such as in the armpit, around the areola, in skin creases, away from bathing suit-exposed areas,” Guenther says. But where the tumor is located really decides where the surgical cut — and scarring — happens. 

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The size of scars depends on the size of your breast, explains Guenther. “A petite woman may have a 4 to 5 inch incision, but a larger person could have up to a 15 or 18 inch mastectomy scar.” Lumpectomy scars, he adds, are much smaller, usually only 1 to 2 inches. Over time, scarring can get smaller, become less obvious, and even be hard to find, but Guenther says scars usually don’t go away completely. 

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While scarring is a natural response to the body repairing itself, complications following a breast cancer surgery can impact healing, explains Ashley Rawlins, PT, DPT. Rawlins is a pelvic physical therapist and Clinical Specialist at Origin. “Issues like edema, lymphedema, muscle weakness, and loss of shoulder range of motion can all complicate scar healing,” she says. 

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Swelling is part of the natural inflammation process, but too much swelling can cause decreased blood flow to the area and pressure and tension to build up around the healing scar, Rawlins explains.

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Pain and fear also keep people from moving, which can lead to a stiffening of muscles and tight and inflexible scars.

Breast cancer treatment

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Many people who receive lumpectomy or mastectomy also receive chemotherapy or radiation therapy or both. Both of these therapies can affect scarring.

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Chemotherapy can suppress the immune system, which increases the chance of infection and poor scarring. Nausea from chemotherapy can also make it hard to eat a balanced diet, which is important for wound healing.

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Radiation therapy can change the texture and color of a surgical scar.

Numbness and nerve pain

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“With procedures such as mastectomy, a significant number of the nerves to our skin are cut or removed with breast cancer,” says Jennifer Geoghegan, MD, a plastic surgeon who specializes in cosmetic and reconstructive surgery of the breast. Unfortunately, this usually causes numbness that won’t go away. 

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Nerve damage may also lead to pain, tingling, itching, or a prickling feeling at or near your scar — for instance, in your chest, armpit, or arm. You may hear this pain called post-mastectomy pain syndrome, but it can also happen after a lumpectomy. 

Hypertrophic scars and keloids

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Hypertrophic scars and keloids can also happen after mastectomy or lumpectomy. Both of these involve an excess growth of collagen that results in raised scar tissue. Hypertrophic scars are more common than keloids. According to Guenther, hypertrophic scars stay in the wound area and may diminish with time.

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Keloids, on the other hand, can grow beyond the original wound edges and often come back after they’ve gone away, says Geunther. “Keloids are heavy scars and can happen with infections, repeated cuts, and in people with a genetic tendency to heavy scars”. 

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Researchers are studying the role of melanin in why keloids form in some people. Melanin gives skin its color and those with more melanin might get keloids more than those with lighter skin colors. 

Changes in breast appearance

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Scar tissue and fluid retention can make breast tissue appear a little firmer or rounder than before surgery. 

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Scar tissue can also form in fat tissue damaged by surgery. If this happens, you may experience some pain, redness, or notice the area right around the incision looks thicker than the surrounding skin. This condition is called fat necrosis. To be on the safe side, always tell your provider if you feel any breast lumps.   

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Managing scars

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People respond differently to the site of scars from breast cancer surgery. One study found that only 26% of lumpectomy respondents and 14% of mastectomy respondents reported minimal or no negative impact as a consequence of the surgical scars.

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For some people, scars can have a long-term psychological impact, says Rawlins. “Even years after cancer is gone, scars remain as a visual reminder of the emotional and physical trauma you went through. They can change the way you feel about yourself — personally, socially, and sexually.”

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If you are feeling discomfort due to your scar, there are options for managing these side effects.   

Medical treatments 

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According to Geoghegan, oxidant or growth factor serums, and silicone tape can reduce the thickness and discoloration of scars. If using serums, make sure your surgical tape or Steri-Strips have fallen off on their own. You can use growth factor serum to help speed up cellular repair, which helps in the scar healing process, says Geoghegan. 

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Other choices for managing scars, says Geoghegan, include laser treatment and microneedling. Steroid injections into scars may also reduce the itchiness and discoloration of some scars, she adds. Over-the-counter silicone scar treatments have been shown to support scar healing. Make sure scabs have healed and there’s no open wounds before you use topical tapes or silicone products. Other topical treatments like Mederma can also reduce the appearance of scars.

Physical therapy

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According to Rawlins, the goals of physical therapy (PT) for scarring are to have less pain and tightness, improve how well the scars move with your body, and lessen their appearance. Common PT treatments include:

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  Dry needling: PTs and other trained health professionals place very thin needles over painful points of muscles to relieve pain.

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  Lifestyle and behavioral management: This can include advice on caring for incisions, and sun protection, or advice on using silicone sheets or gel on scars.

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  Myofascial release: This is a type of scar massage that focuses on the breast, chest, and shoulder areas that uses pressure to ease pain and improve mobility.

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  Laser therapy: This uses a focused beam of light to reduce the appearance of scars. Research shows it’s an effective way to help keep scars soft and pliable to decrease pain. 

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“PT treatments can be really beneficial,” says Rawlins, “Research has shown these physical therapy scar management techniques are moderately to highly effective at improving scar pain and itch, pigmentation, elasticity, and thickness.” PT can also help teach you self-massage and using compression garments, so you can be an active participant in your own recovery. 

Tattooing scars

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Some people look to create art out of the scars left behind by surgery. Instead of a breast reconstruction following a mastectomy, some people choose to get a tattoo. As one 2020 study states, these tattoos help convey “what constitutes beauty, femininity, and sexuality” and help people “reclaim their body” after surgery. Another study says tattooing scars can “return a sense of control” over your body. 

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If you decide to get a tattoo, keep these tips in mind for care and safety:

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  Make sure you go to a reputable tattoo studio who is licensed

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  Wash the area twice a day with gentle soap and water. Don’t rub your skin.

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  Use moisturizer several times a day

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  Keep the tattoo out of direct sunlight.

What you can do at home

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There are a few things you can do at home to help ease scarring discomfort, according to Dr. Rawlins. She suggests:

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  Following your post-op instructions. Those instructions are important for your safest recovery.

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  Keeping your scar clean, dry, and moisturized. This can help prevent any complications with the healing process. Geoghegan recommends fragrance-free and gentle moisturizers to soothe and hydrate scars. Stay away from products with harsh ingredients that can cause irritation. 

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  Doing gentle movement and exercises on your own. This can help keep the scar flexible and pliable for your comfort.

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  Being mindful of your posture. Poor posture can cause scar tissue to tighten on the front of your body. As you are able, stand or sit with your shoulders down away from your ears and your chest open.

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Scars are an inevitable part of breast cancer surgery or reconstruction, but there are ways to manage how they look and feel. Talk with your care team about any questions and concerns you have.

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This information made possible in part through the generous support of www.BreastCenter.com.