Can post-mastectomy scars or dents be improved with fillers? For a Cancer Warrior.

Hello and thank you for all your very useful information. I love your website! I have a question about using dermal fillers to help with depressions around surgical scars. I had a unilateral mastectomy with implant reconstruction 10 years ago, at age 51. About 18 months ago, my surgeon did a nipple transfer and a very talented medical tattoo artist created an amazing areola. At the time of the revision surgery my plastic surgeon did a fat transfer to add volume to a depression in the area above and around my mastectomy scar. It looked amazing but the fat has been reabsorbed and it's back to about where it started. Other than that, I'm very pleased with the reconstruction! The surgeon has offered to try to fill it again with fat, but it's hard to find enough to use on me and I'd like to avoid another surgery with anesthesia. Can fillers be used for this purpose? I realize they are not permanent either but it is more appealing and less expensive than surgery. The skin is very thin at the surgical scar site. Thank you in advance! A Cancer Warrior.

Thank you, and thank you for asking this! We see many patients at our clinic with post-mastectomy scars and dents, and this is becoming more of an issue due to the frequency of breast cancer in our country. Most women who’ve had mastectomies would like these things from their breast implant reconstructions:

  • Compassionate and considerate care from their health care team;
  • A breast shape and size that looks as much like they used to as possible (or maybe just a little larger);
  • Scars that blend well and don’t remind them every day of events that it would be nice to forget about so that they can get on with life;
  • And nipples, that don’t necessarily look perfect but are reasonably similar.

If the surgery didn’t give you the exact results you wanted, you have options to further help with left over scarring and dents.

First, consider a fat transfer for improving implant contour

There are several important considerations. First, if you have enough fat to transfer and a good surgeon, a fat transfer may be the way to go. Smaller fat transfers may be done with local anesthetics and not general anesthetics. Fat grafting has become a popular procedure after breast reconstruction to help refine the contour. Talk to your surgeon.

Dermal fillers CAN be used for post-mastectomy dents

A dermal filler would be a temporary fix that would need maintenance. Any filler listed below needs an absolutely sterile technique to inject around a breast implant pocket. Injections should never be into the breast implant pocket. That pocket needs to be kept sterile. That’s why the doctor should prep and sterilize the skin with chlorhexidine or iodine swabs 3 times. Also, alcohol can be used over that, if needed. The setup and needles should be sterile as well. Here’s my two recommendations for a dermal filler:

  1. My first filler choice for mastectomy scars would be the longer lasting hyaluronic acid fillers like Voluma or Restylane Lift.  You get immediate results, and it’s easily adjustable if it isn’t quite right the first time.  The downside: it’s expense (think multiple syringes) and it requires an artistic eye on the part of the injector.  You’ll need maintenance treatments one to two times a year. FDA off-label use.
  2. Sculptra can be used in some situations. Generally, you’ll require three sessions about two to three months apart. And the finished result takes about 6 months to see. After that, it is low maintenance, with one treatment a year. An expert at this is a must, because body dilutions and techniques for Sculptra are different than for the face. Sculptra has the advantage of building your own collagen and generally improving scar tissue appearance also. FDA off-label.

Lasers to treat the mastectomy scars themselves

Powerful IPLs and the pulsed dye lasers are good for removing the red out of scars. I recommend the fractionated CO2 laser to blend wide or unsightly scars.  A patient usually needs 3-10 treatments over 1-2 years, depending on the scar.

Hope this helps,  Dr. I

Dr. Brandith Irwin, MD

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Hi, I’m Dr. Irwin. I believe that consumers deserve a medically trained and unbiased skin care advocate.

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