Scarring and Breast Cancer Treatments

Understanding the Causes, Risks, and Healing Process

In This Article

Many women will worry about the risk of scarring from breast cancer treatment. If you have been diagnosed with early-stage breast cancer, typically defined as between stage 0 and stage 3A, you will likely have surgery. Unfortunately, any time an incision is made, you will inevitably have some sort of scar. Although plastic surgery can help minimize the appearance of a scar, it can't erase it. With that being said, you shouldn't presume that you will be forced to live with an ugly scar for the rest of your life.

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

Causes

People typically associate breast scarring with surgical procedures like lumpectomy or mastectomy, but there are other procedures used in 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 not leave a visible scar (other than when you're wearing a swimsuit). However, it can cause skin tightness. In some cases, the tightness can lead to the stretching of scar tissues, making them all the more visible.

Breast Cancer Doctor Discussion Guide

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Risk Factors

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

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

Scar tissue will sometimes overgrow the boundaries of a wound, creating a puffy protrusion called a keloid. These may be caused by stretching, large incisions, or poor wound management but are most often influenced by genetics.

In terms of skin types, people with fair skin and freckles or those with dark brown or black skin are more likely to develop abnormal scarring

Ways to Limit 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 avoiding letting them dangle as they can fall out and provide easy access for bacteria. Once removed, you need to follow your doctor's instruction regarding bandage changes.

Smoking can cause delayed healing and should be stopped if you intend to minimize scarring. Drinking alcohol should also be avoided as it can lead to dehydration, reducing the flow of oxygen and immune cells to the injury site.

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 doctor 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 feelings 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.

If you are prone to keloids, ask your doctor about steroid injections which can temper inflammation and help prevent tissue overgrowth.

Other Treatment 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 less effective in women with dark skin. Fat injection 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 an unsightly scar is to conceal it with a tattoo. This is an option gaining popularity among younger women especially.

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. Any keloids would be resected (cut away). The blunt tissue ends would then be reconnected with delicate sutures (stitches).

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 (either an IGAP flap taking skin from your buttocks, a TRAM or DIEP flap taking skin from your abdomen, a latissimus dorsi flap taking skin from your back), there will be scarring at the site where the tissue was harvested.

It is important to understand the implications of any surgery you intend to undergo, even elective ones designed to improve your appearance. Try to manage your expectations and decide which breast issues you can cope with and which need treatment.

These cosmetic issues should be discussed even before the primary surgery begins. Doing so can help you and your surgical oncologist decide which procedures are most appropriate based on your cancer stage and treatment goals.

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.

Many cancer centers now have programs, such as the STAR (Survivors Taking Action and Responsibility) program, that provide cancer survivors with rehabilitative services ranging from physical therapy to counseling. Joining a support group is also helpful for women wanting to accept—and hopefully celebrate—their new body image.

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