Scarring and Breast Cancer Treatments

Many women will worry about scarring from breast cancer treatment. This may be an obvious concern for breast surgeries, but it can also occur due to radiation treatment. Some people, such as younger individuals and smokers, may be more prone to scarring. While plastic surgery can help minimize the appearance of a scar, it can't erase it.

By understanding the causes of scarring and the factors that influence them, you may be able to alleviate this common consequence of some breast cancer treatments.

Causes

People typically associate breast scarring with surgical procedures like lumpectomy or mastectomy, but there are other aspects of cancer treatment that can produce scars as well.

Among the examples:

• Surgical drains placed in your breast after surgery will leave small round scars when removed. The amount of scarring will depend on how many drains were used and how long they were in place.
• Chemotherapy ports placed for chemotherapy will leave a scar at the incision site just above the breast near the collarbone.
• Radiation therapy can induce fibrosis, the abnormal accumulation of fibrous connective tissues. This can lead to an uneven thickening of the skin. Even some of the short-term effects—like chafing and blistering sores—can leave permanent marks. It is also not uncommon to have a permanent "suntan" on your chest after undergoing extensive radiation treatment.
• Lymph node dissection and removal may leave a scar, but likely one that's only visible to others when you're wearing a swimsuit. It can also cause skin tightness which, in some cases, can lead to the stretching of scar tissue, making it all the more visible.

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Breast Reconstruction

Breast reconstruction is used to rebuild a breast following a mastectomy or to even out breast tissues following a lumpectomy. The procedure is most often performed by a plastic surgeon who is skilled in minimizing scars.

Oftentimes, the surgeon will use the same incision site used for the mastectomy or lumpectomy to avoid the formation of new scar tissues.

If large amounts of skin were resected in the original surgery, the plastic surgeon may recommend a breast reduction to reduce pressure on the incision, thereby limiting scarring.

If the surgeon performs a flap procedure, there will be scarring at the site where the tissue was harvested (e.g., your buttocks if an IGAP flap is performed).

It is important to understand the implications of any surgery you intend to undergo, even elective ones designed to improve your appearance. In addition, try to manage your expectations.

Risk Factors

The amount and extent of scarring caused by breast cancer treatment depend on several factors, including the type of surgery performed (if applicable), your propensity for scarring (including your genetics and skin type), and various other factors that influence scar formation.

In general, those more likely to develop abnormal scarring include people with:

• Dark brown or black skin
• Fair skin
• Freckles

According to a 2013 study in the Journal of Plastic Reconstructive and Aesthetic Surgery, there are five additional factors associated with hypertrophic scars (the types associated with lacerations and incisions):

• Younger age, due to the rapid production of collagen
• Bacterial skin infection, including post-operative infections
• Smoking, which causes capillaries to narrow, impeding healing
• Stretching of the wound (common with especially long incisions)

Ways to Reduce Scarring

While scarring cannot be prevented, there are ways to manage them so that they heal properly and are less visible over time. Care would begin immediately following surgery and continue for at least a year—the general period of time during which scar formation completes and skin discoloration tends to normalize.

Post-Surgical Care

One of the best ways to reduce scarring is to avoid infection after your surgery. This is especially true when you return home from the hospital with surgical drains.

In addition to keeping the drains clean and dry, you need to avoid letting them dangle, as they can fall out and provide easy access for bacteria. Once removed, you need to follow your healthcare provider's instruction regarding bandage changes.

You would also be well served to avoid sun exposure, which can promote inflammation and make the scar all the more apparent. If you need to be outdoors, wear a light top until the skin is fully healed and apply sunscreen.

Long-Term Recovery

Once the wound is sufficiently healed and your healthcare provider gives you the OK, you can aid in your recovery by engaging in the daily massaging of the scar tissue. Known by physical therapists as transverse friction massage, the technique involves the gentle manipulation of the skin above and below the incision, starting from the collarbone to the bottom of the rib cage and continuing from the breastbone to under the armpits.

Physical therapists may also use deep tissue and soft tissue massage to relieve pain and the feeling of constriction. Light stretching and arm exercises are also recommended to restore upper body mobility and gently release tight tissues. Acupuncture may also be used to decrease pain.

Cosmetic Options

Once the scar is fully healed, chemical peels, laser therapy, and topical bleaching may improve the appearance of a scar, although the results are highly variable and tend to be less effective in women with dark skin.

Fat injections and dermal fillers are also sometimes used to bolster skin depressions caused by large incisions. Wait at least a year before you explore options like these.

Another unique way to deal with a scar is to conceal it with a tattoo.

A Word From Verywell

Scarring caused by breast cancer treatments can be distressing. It can affect your body image and, in doing so, create problems with intimacy and relationships. If your scars are bothering you a lot, ask yourself whether the emotional scars of treatment may be playing a role. It sometimes helps to speak with a therapist who can help you navigate these difficult and often intersecting emotions. Joining a support group is also helpful for women wanting to accept—and hopefully celebrate—their new bodies.