Traditional Surgery for Fibroadenoma: Considerations for Scar Management

Traditional surgical methods for the excision of fibromas?

Hello! After discussing with my attending physician yesterday, we decided to remove both fibroadenomas in my left breast (one measuring 1 cm at the 3 o'clock position and the other measuring 1.2 cm at the 4 o'clock position) using traditional surgical methods.
Since I have a keloid tendency, my wounds are prone to scarring.
I informed my attending physician about this, and he mentioned that he would make the incision at the edge of the areola to help conceal the scar post-surgery.
However, I later thought about it and wondered if a raised scar at the edge of the areola would be more unsightly than a scar on the surface.
Additionally, wouldn't scar care be more complicated afterward?
1.
Doctor, is it appropriate to perform the incision at the edge of the areola if I have a keloid tendency?
2.
I read online that patients undergoing breast augmentation need to perform regular massages to prevent scarring and capsular contracture.
Will I also need to do regular massages after my surgery? (I am concerned about the possibility of my breast becoming hard, or developing indentations or deformities post-surgery.) Thank you!

ting, 20~29 year old female. Ask Date: 2017/09/30

Dr. Chen Jiaming reply Surgery

1.
Because the edge of the areola is at the junction between the areola and normal skin, it is generally less noticeable regardless of the presence of keloids!
2.
Absolutely not! This is a completely different procedure.
If the postoperative wound experiences unnecessary tension (such as from massage), it may lead to excessive scar tissue formation (widening or protrusion).
It is recommended to use cosmetic gel postoperatively.

Reply Date: 2017/09/30

More Info

When considering traditional surgery for fibroadenomas, especially in patients with a predisposition to keloid formation, there are several important factors to take into account regarding scar management and overall surgical outcomes.

1. Surgical Approach and Scar Location: Your surgeon's plan to make an incision at the edge of the areola is a common technique aimed at minimizing visible scarring. This approach can help conceal scars within the natural pigmentation of the areola, which may be less noticeable than scars on the breast surface. However, for individuals with keloid tendencies, even well-placed incisions can lead to hypertrophic or keloid scars. It is essential to communicate your concerns with your surgeon, as they may have specific techniques or recommendations to further minimize scar formation.

2. Keloid Formation Considerations: Given your history of keloid formation, it is crucial to discuss this with your surgeon. They may consider using techniques such as tension-free closure, which can reduce the risk of scar formation. Additionally, they might recommend the use of silicone gel sheets or silicone ointments post-surgery, which have been shown to help flatten and soften scars. In some cases, corticosteroid injections may be used to manage keloids if they do develop.

3. Postoperative Care and Massage: Post-surgical care is vital for optimal healing and scar management. While breast augmentation patients often perform massage to prevent capsular contracture, the necessity for massage after fibroadenoma surgery may not be as critical. However, gentle massage around the surgical site can promote blood flow and may help in softening the scar tissue. It is advisable to follow your surgeon's specific recommendations regarding massage and any other postoperative care.

4. Monitoring for Changes: After surgery, it is essential to monitor the surgical site for any signs of abnormal healing, such as excessive redness, swelling, or changes in the texture of the scar. If you notice any concerning changes, it is important to contact your healthcare provider promptly.

5. Psychological Impact of Scarring: The psychological impact of scarring, especially in visible areas like the breast, can be significant. It is essential to have realistic expectations about the surgical outcome and the appearance of scars. Engaging in discussions with your surgeon about your concerns can help alleviate anxiety and provide clarity on what to expect.

6. Long-term Management: If you do develop keloids or hypertrophic scars, there are various treatment options available, including laser therapy, cryotherapy, and surgical revision. It is beneficial to have a long-term plan in place with your healthcare provider for managing any potential scarring issues.

In conclusion, while the surgical approach to removing fibroadenomas can be tailored to minimize scarring, individual factors such as your predisposition to keloid formation require careful consideration. Open communication with your surgeon about your concerns and preferences is essential for achieving the best possible outcome. Postoperative care, including scar management techniques, will play a significant role in your recovery and satisfaction with the surgical results.

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