Supporting women whose lives have been touched by breast cancer

Preventing and treating hypertrophic scars

By Being Sarah

I received my breast cancer diagnosis in February 2007, and a few weeks later had a mastectomy. Although my major concern was about the cancer, I was also worried about the scarring. This was because I’d had dermabrasion years ago on my face for an acne scar and it had formed a small keloid. A keloid is a type of scar which heals with too much collagen and tends to overgrow, sometimes producing a lump many times larger than that of the original scar. The keloid on my face was eventually flattened using steroid injections over several months, but it was not a pleasant experience.

After about ten weeks my mastectomy scar started to become hypertrophic, that’s a medical term for a scar that is red and raised above the skin. It is hypertrophic if it does not grow beyond the boundaries of the original wound, but may go on to form a keloid.

The first treatment was a silicone dressing by Cica Care. This is a clear thick rubbery sheet that is cut to size and used to cover the scar. Wear is gradually increased until it is worn 24 hours a day. I found it fiddly to use and it would often fall off in bed. After about three months of using this I switched to Dermatix gel, a silicone gel, which works in the same way, it is another silicone treatment. Both these treatments did not have much effect on the scar, but equally it didn’t get any worse.

The next step was steroid injections. The mastectomy scar was covered with a local anaesthetic cream (Emla). This is left for about 30 minutes. Then the injection is done. The steroid liquid is injected into several areas of the scar. Even with the anaesthetic this is not very comfortable. The scar also bleeds, and was sore and painful as the anaesthetic wears off. But, the scar did gradually start to improve. The injections were then repeated about every six weeks, and were done about four times in total. I then continued to use steroid tape for a few more weeks. So, by nine months after surgery, my scar was flat, soft, still a bit purple, but much less noticeable and I was happy with it. I continued to massage the scar using rosehip oil, and it did become very soft.

In November 2007 I had a prophylactic oophorectomy done by keyhole surgery. I was 44 so the result of this was surgical menopause, which is a whole other topic completely! This was done to reduce oestrogen levels, I had already had Zoladex for three months but not found the experience very good, so decided on the oophorectomy. But because of the problems I had with the scarring I wanted to avoid a repeat of the scar treatments. My gynae surgeon was not very supportive about this, he said that the incisions were very small and it wouldn’t be a problem. My breast surgeon, however, was much more supportive, having seen the problems I’d experienced. So she suggested I use a silicone tape as a preventative measure before the scars had developed. This time she prescribed Mepiform tape, which is adhesive, thin, and a sort of beige colour. It’s much easier to use than the Cica Care silicone sheets, it stays in place well, and on my pale skin it’s actually not very noticeable, although obviously it is covered by my clothes anyway.

I used the Mepiform tape as soon as my wounds were closed, about two weeks after surgery, and I’d had the stitiches removed. Although I learnt afterwards that you are supposed to build up the wear gradually, I started wearing it all the time straight away. I had four small incisions, two on my abdomen and two either side of my tummy button. I cut special shapes to cover the tummy button. The results were really good. After only a few months I had very neat white flat scars. I am glad I took the trouble to do this as one of the abdominal scars is now on my ‘new’ breast, as I went on to have DIEP reconstruction, but a lot later on.

During 2008 I thought a lot about reconstruction. I was concerned about the scarring. I saw one GP who dismissed reconstruction as an option for me because of the scar problems I’d had. However, when I went to the hospital where I did have my DIEP, I was reassured because they are a specialist burns and plastics unit, and have a scar management consultant, so I felt sure they could get the best result for me.

In May 2009 I had my DIEP surgery. There are two big wounds from this surgery, a hip to hip incision across the abdomen, and the suture line round the new breast to attach the flap. After the wounds had healed I started the Mepiform tape. This was after about six weeks for my breast, and about eight weeks for the abdomen. I’ve used the tape now for about two months. The scars are still quite red, my consultant actually says they are the colour of hypertropic scars, but they are completely flat. I will continue the Mepiform for another three months, and maybe another three after that if the appearance is still improving. In a few months I will be having a mastopexy (lift) on my other breast to match the DIEP and will use the Mepiform on those scars too.

My consultant has told me that Mepiform basically speeds up the skin’s scar formation, and a scar can take up to three years to fully mature without treatment. Mepiform will only give the best result that you would get naturally, and not everyone produces very neat thin white lines naturally. You can buy Mepiform on the internet but it is very expensive, especially if you have a lot of scars and use the big sheets, but it is available on prescription.

Even though this is a long term treatment I don’t find it a big inconvenience to use the Mepiform as once it’s on I leave it in place for a few days, in the shower, bath and swimming, then I wash it and replace it. And I am very pleased with the results so far, both the appearance of the scars and the results of the DIEP.

August 2009