Visible scars on a reconstructed breast are an ever-present reminder of mastectomy and reconstruction. Surgery and scars go hand-in-hand; scars form as the body’s healing process floods the incision with collagen, the body’s version of spackle.
The evolution of a scar
Reconstruction is performed through the mastectomy incision. If you have immediate reconstruction (at the same time as your mastectomy), your plastic surgeon will place a breast implant or tissue flap before the mastectomy incision is closed; your breast surgeon and plastic surgeon work together to decide on the location and length of the incision. (Many women, especially those who have larger breasts, require more than one incision to adequately allow for removal of the breast tissue.) If you have delayed reconstruction, your mastectomy incision will be reopened to facilitate your reconstruction.
Mastectomy incisions cut through the dermis, the thick tissue beneath the skin; that initially produces red, prominent scars. They fade to pink after a few weeks, as collagen and new blood vessel facilitate healing. Mastectomy scars never disappear, but they can often be hidden under the new breast or by a tattooed areola. A year or two after mastectomy, most scars have faded to thin white lines.
Your genetics and age, the depth of the incision, and how the underlying tissues were sewn influence how your incision heals and how your scar will eventually appear. Smoking and poor circulation, which inhibit blood flow, may impede healing and contribute to larger, angrier-looking scars. Two women who have identical mastectomy and breast reconstruction procedures by the same surgeons may have scars that look very different. Your scars from previous surgeries will give you a good idea of how your mastectomy/reconstruction scars may appear.
What you can do to improve the appearance of scars
Despite a booming market in “scar improvement” products, no well-documented studies have found any topical treatment that significantly improves the appearance of a surgical scar. But you can take steps to promote healing and make your scars look smoother and less noticeable.