What to know about mastectomy scars
During a mastectomy, a surgeon removes tissue from one or both breasts, taking out either a portion or the whole breast. The scarring afterward depends on the location and type of incision the surgeon makes.
A surgeon will decide on the approach, depending on the amount of breast tissue that needs removing, and if a person wants reconstruction surgery afterward.
Mastectomy scars can take months or several years to fade but never disappear entirely. Breast reconstruction can improve their appearance.
In this article, we look at different approaches to mastectomy and how these affect scarring. We also explain how to treat post-mastectomy scars.
Different approaches to incision
The appearance of mastectomy scars will depend on the type of incision.
The appearance of a mastectomy scar will depend on the surgical approach and type of incision.
To begin the procedure, a surgeon will make an incision in the chest skin to expose the inner breast tissue.
Once the surgeon has removed the breast tissue, muscles, and lymph nodes, they will use stitches to close the incision.
As the wound heals, a scar will form. Despite the different approaches, most mastectomy scars heal in a horizontal line across the chest, a diagonal line, or sometimes in a half moon shape.
Often, the incision type and resulting scar depend upon the original location of the breast cancer lesion.
Surgical approaches have significantly developed with medical technology, and a range of options is now available. People can ask their surgeon for advice about a procedure and its possible outcomes.
Which mastectomy will cause scarring?
While all forms of mastectomy will result in some scarring, the extent of scarring depends on the type.
Partial mastectomy or lumpectomy
A partial mastectomy involves removing the tumor and some surrounding breast tissue. Sometimes, the surgeon will also remove a section of the lining that covers the chest muscles.
A lumpectomy will usually leave a small linear scar on the breast. A surgeon may hide the scar by making the incision in the crease beneath the breast or around the nipple.
With a partial mastectomy, a surgeon often leaves the majority of the breast intact, and reconstruction is not usually necessary.
Depending on the size of the breast and amount of tissue removed, it is possible that the breast may be smaller than the one on the other side.
The resulting breast might also have a divot or depression if it is small and the mass removed is particularly large.
Women who have a lumpectomy will usually require radiation therapy after surgery.
Skin sparing mastectomy
A surgeon will usually choose this approach for women who want to follow the procedure with immediate breast reconstruction.
A skin sparing mastectomy involves removing the breast, areola, nipple, and one or more lymph nodes. However, the surgeon will preserve the remaining skin of the breast.
Saving most of the breast skin allows the surgeon to start immediate reconstruction with an implant or tissue from elsewhere in the body.
A skin sparing mastectomy usually leaves a visible, medium-to-large scar on the front of the breast.
Nipple sparing mastectomy
A person who is due to receive a preventive mastectomy or has early stage breast cancer may be a candidate for a nipple saving mastectomy. This procedure involves preserving the skin and areola.
People with smaller breasts are likely to benefit from this approach. It will result in a scar on the side or at the base of the breast. Placing the incision in the crease under the breast can hide the scar more.
Simple or total mastectomy
This type of mastectomy is a surgical approach that involves removing the breast, areola, and nipple. Sometimes, a surgeon will also remove the lymph nodes as well if they show signs of cancer.
They may also vary the amount of breast skin they remove during the procedure, depending on plans for reconstruction.
The surgeon typically makes an oval shaped incision that goes around the nipple and across the width of the breast, leaving a visible scar across the chest.
Modified radical mastectomy
Similar to a simple mastectomy, this approach involves removing all breast tissue plus lymph nodes in the breast and armpit. The surgeon often leaves the chest wall intact.
A modified radical mastectomy will result in a large, visible scar on the chest.
Recovery can take weeks, and a person may require chemotherapy.
The goal of a mastectomy or any oncologic surgery is to remove only as much tissue as is necessary to treat cancer, which can help limit any scarring.
A breast surgeon and oncologist will discuss the options and help an individual reach the best decision in their case.
After surgery, a woman will likely have drainage tubes and need several weeks to recover.
Some procedures, such as a lumpectomy, do not typically require a stay in the hospital. Larger mastectomies, however, often mean a hospital stay.
The type of mastectomy and reconstruction often dictate the duration of the hospital stay and length of recovery time.
Following the mastectomy, a doctor may recommend radiation therapy or chemotherapy to shrink a tumor or destroy any remaining cancer cells. These treatments can also affect wound healing.
A woman should monitor the wound for signs of infection, such as warmth, redness, or discharge. A fever may also indicate a systemic infection.
Breast reconstruction is an option after a mastectomy. A surgeon will recreate the appearance of the breast or breasts, either at the time of mastectomy or after recovery.
Breast reconstruction can still cause scarring but will lead to a more complete look to the breast rather than a flat scar on the chest. The procedure may also reduce the psychological impact of a mastectomy.
A surgeon will achieve the reconstruct by taking tissue from another part of the body, using breast implants, or both.
Image credit: National Cancer Institute, 2013
Image credit: Cancer Research UK, 2016
What if a woman does not choose reconstruction?
According to BreastCancer.org, an estimated 44% of women undergoing mastectomy do not choose to follow the procedure with breast reconstruction.
Many women select this course for various medical and personal reasons. Some of these may include:
- health concerns that could make later surgeries dangerous
- the desire to resume daily activities more quickly
- concerns about taking tissue from other areas or using an implant
- worries about cost for people without insurance
Those who do not choose reconstruction may elect to wear a prosthesis or artificial breast that they can insert into a bra. One option is an adhesive, breast-shaped device that attaches to the body.
Females not choosing one of these options sometimes refer to their decision as "going flat."
Reducing scarring without reconstruction
If a person decides against reconstruction, they should talk with their doctor about surgical options that can make the mastectomy scar and resulting skin more comfortable.
For example, a surgeon can ensure that the scar lies as flat as possible against the chest, which can make the chest feel smooth. Otherwise, the surgery may leave a person with skin on their chest that bulges.
While this bulging is not physically harmful, many people do not like its appearance.
Sometimes, a surgeon may make what they call a "Y" incision or an anchor pattern. This technique adds two small incisions to the end of the traditional long incision, which can reduce bulging skin after the procedure.
In 2017, the Journal of the American Medical Association published an article by a tattoo artist who worked with females to cover their mastectomy scars with tattoos.
This is an emerging approach that can be an option for people who choose not to have breast reconstruction.
Some individuals also choose to have a tattoo artist design a nipple that looks three dimensional. Certain tattoo artists specialize in this approach.
The decision to reconstruct a breast, cover a mastectomy scar, or live life without wearing a prosthesis is an individual choice. It is essential that people discuss all these options with a surgeon.
If a person feels that a doctor is not respecting their wishes about reconstruction, they may wish to get a second opinion.
A person may also choose to delay any decision regarding the reconstruction process until after a mastectomy.
Is there a natural way to reduce scarring following a mastectomy?
Scars can be a normal part of healing. It is important to remember that every person has different scarring tendencies, and each surgery is unique.
Your surgeon will do their best to optimize your incision and, therefore, your scar, but once the surgery is over, your body will do the major work to heal the incision.
Most scars will look worse before they get better, often becoming darker and pinker in the first few weeks and months before starting to fade. While your body is healing and rearranging the collagen in your skin, it may take up to a year or so to see how your scar will look permanently.
While you are healing, there are some things you can do to help ensure your best possible outcome.
Avoid smoking. Tobacco products, including vaping ones, have been shown to impair healing. An incision with poor blood flow due to smoking will likely become an inferior scar.
Avoid sun exposure. The UV rays in sunlight are known to darken and damage your skin, and the same is true for healing incisions. Avoid sun exposure to the incision if possible, and if it must be exposed, regularly apply sunscreen of at least factor 30.
Scar massage. Once your surgeon has decided that you are healing well, they may instruct you to gently massaging the scar to help soften the tissue. You may also use lotion, vitamin E oil, or cocoa butter to massage the scar; however, there is no evidence that these creams improve the appearance of a scar.
Silicone sheets. Some data suggests that silicone sheets may improve the color and appearance of the scar. Once your surgeon has cleared you, place the sticky clear silicone patches on your scars and wear them as much as possible during the weeks after surgery. You can buy the sheets at most pharmacies or specialty stores. Ask your surgeon if you can use silicone sheets to improve your scarsCatherine Hannan, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.