How to Reduce Scars after DIEP Surgery

Effective Strategies for Scar Reduction Post-DIEP Surgery

If you’ve recently undergone DIEP surgery, you’re likely well aware of the importance of managing scars as part of your recovery. This surgery leaves scars, both at the donor site on the abdomen and at the reconstruction site on the breast. How these scars heal can significantly affect your physical recovery. Effective scar management is therefore not just about improving how the scars look; it also helps in reducing potential complications like infections and ensures a smoother recovery.

Scar management after DIEP surgery is a process that begins right from the moment your surgery ends and continues throughout your recovery period. Initially, the focus is on keeping the surgical sites clean and protected from infection. As you move further along in your recovery, you’ll start using specific products and techniques designed to minimise scarring.

It’s important to remember that each person heals differently and what works for one person may not work for another. However, by following a well-structured scar management plan, you can improve your chances of minimal scarring. In this blog, Sydney Specialist Plastic Surgeon Dr Bish Soliman aims to equip you with the knowledge you need to effectively manage your scars, with advice on everything from the type of dressings to use in the early days to professional treatments that can be considered.

Scars after DIEP Surgery

DIEP surgery, or Deep Inferior Epigastric Perforator surgery, is a procedure used primarily for reconstructing a breast following mastectomy. Unlike other forms of reconstruction that might use artificial implants, DIEP surgery uses your own tissue. This tissue, including skin and fat, is taken from your lower abdomen, which is why some people refer to it as a “tummy tuck – abdominoplasty” reconstruction.

The procedure involves carefully removing skin and fat from the belly area while keeping the muscles and nerves intact. Dr Bish then reconnects the blood vessels from this tissue to the blood vessels in the chest using microsurgery techniques. This approach helps to form a new breast mound that feels more natural and uses your own body tissues, reducing the risk of rejection that can sometimes occur with implants.

However, because this surgery requires incisions both in the abdominal area where the tissue is taken and in the breast area where this tissue is placed, scarring is inevitable. The size and visibility of these scars largely depend on several factors including the specific techniques Dr Bish uses, your body’s natural healing abilities, and how well you follow post-operative care instructions.

DIEP surgery scars are usually located across the lower abdomen, horizontally, similar to a tummy tuck- abdominoplasty scar. You might also have scars around the new breast mound, depending on how the reconstruction is done. These scars can be significant and are permanent, although they will fade over time and can be made less visible with proper care.

Early Scar Management Techniques

After undergoing DIEP surgery, managing your scars starts right away. The way you care for your surgical wounds in the early stages can greatly influence how your scars heal and develop. Here’s what you need to know about keeping the area clean and managing dressings properly:

Importance of Keeping the Area Clean

Keeping the surgical area clean is your first line of defence against infection, which can worsen scarring. Infections can lead to more significant scarring because they disrupt the normal healing process and may cause additional damage to the tissue. To avoid this:

• Follow Dr Bish instructions carefully for cleaning the wound. Usually, this will involve gently cleansing the area with a mild soap and water or a saline solution, as advised by your healthcare team.
• Wash your hands thoroughly before and after touching the incision site to avoid introducing bacteria to the wound.
• Change any bandages or dressings as often as recommended by Dr Bish. This not only keeps the area clean but also avoids moisture build-up, which is a breeding ground for bacteria.

Dressings and Wound Care Essentials

Dressings are not just for keeping the wound clean; they also keep it protected from external irritants and support the healing environment. Proper dressing management is essential for effective scar management:

• Use the specific type of dressing that Dr Bish recommends. There are many types available, including standard gauze, adhesive dressings, and advanced options like hydrocolloid or silicone gel dressings that can help in keeping the wound moist and encourage better healing.
• Ensure that dressings are applied correctly. This means they should fully cover the wound but not be applied too tightly, which can restrict blood flow and delay healing.
• Be attentive to signs of dressing degradation or saturation. If a dressing becomes loose, dirty, or soaked through with fluid (such as blood or wound exudate), it needs to be changed immediately.
• Keep an eye on the amount of drainage from your wound. Excessive drainage or a sudden increase in drainage can be a sign of complications, such as infection.

Advanced Wound Care Products

As part of your recovery from DIEP surgery, you may be advised to use advanced wound care products. These products are designed to improve the healing of your wounds and to minimise the appearance of scars.

Silicone Sheets and Gels

Silicone sheets and gels are highly recommended for scar management due to their effectiveness in improving the appearance of scars. Here’s how they work:

• Protection and Hydration: Silicone sheets cover the scar, providing a protective barrier that prevents bacteria and other contaminants from entering the wound. They also maintain hydration around the scar area, which helps to soften the scar tissue and reduce redness and itching.
• Pressure and Support: These sheets apply gentle pressure to the scar, which can prevent the scar from raising above the skin level. This pressure also supports good alignment of the collagen fibres, which are the main proteins in scar tissue, making the scar less noticeable.
• Ease of Use: Silicone gels provide the same benefits but in a different form. They can be easier to apply, especially on areas where sheets might not adhere well. The gel forms a thin, waterproof layer that has similar protective and hydrating effects.

To get the best results, you should start using silicone products once your wound has healed sufficiently and Dr Soliman gives the go-ahead. These products are usually used for several months to ensure optimal scar formation.

Oral Medications

Alongside topical treatments, oral medications might be prescribed to aid in scar reduction and general recovery:

• Antihistamines: If itching is a problem, which it often can be with healing scars, antihistamines might be recommended to help manage this symptom. Itching can lead to scratching, which can worsen scarring, so controlling this is key.
• Vitamin supplements: Dr Bish may recommend vitamin supplements to support wound healing. For example, Vitamin C is known for its role in the production of collagen, an essential part of the skin’s healing process.
• Anti-inflammatory drugs: Non-steroidal anti-inflammatory drugs (NSAIDs) can be used to reduce inflammation around the wound site, which might help in minimising scarring by reducing swelling and redness.

Professional Scar Treatment Options

Once your DIEP surgery scars have sufficiently healed and you’ve moved past the initial stages of recovery, you might consider professional treatments to further reduce their appearance. Two effective treatments are laser therapy and microdermabrasion, among other options. Here’s an overview of how these treatments work and what you can expect:

Laser Therapy

Laser therapy is a popular choice for scar treatment after DIEP because of its effectiveness in reducing scar visibility and improving skin texture. Here’s how it helps:

• Precision: Laser therapy uses focused light beams to target scar tissue. This precise application allows the treatment to reach deeper layers of skin without affecting surrounding areas.
• Stimulation of New Skin Growth: The laser light gently removes the outer layers of scar tissue, stimulating the growth of new, healthier skin cells beneath. This can help reduce the thickness of the scar and improve its colour and texture.
• Collagen Production: The heat from the laser also promotes collagen production in the treated area. Increased collagen can help to smooth out the scar, making it less noticeable.

Laser therapy sessions are usually quick, ranging from a few minutes to an hour, depending on the size and number of scars being treated. You may need several sessions to achieve the best results. It’s important to have a detailed discussion with Dr Bish about what laser therapy can realistically achieve for your scars.

Microdermabrasion and Other Treatments

Microdermabrasion is another technique often used to improve the appearance of scars. This treatment involves:

• Exfoliation: A specialised device is used to gently sand away the upper layers of skin. This process removes or diminishes the outermost layer of dead skin cells, promoting new skin growth which is often smoother and healthier.
• Stimulation: Like laser therapy, microdermabrasion stimulates the skin to regenerate, encouraging a reduction in the visibility of scars.

Microdermabrasion is generally considered a safe procedure for most skin types and colours. Sessions can last anywhere from a few minutes to an hour and may need to be repeated over several weeks or months, depending on the scar’s characteristics.

Other treatments might include chemical peels or fillers, which can also help in reducing the appearance of scars by smoothing out the skin surface or filling in the scar depression, respectively.

Natural Remedies to Consider to Reduce Scars after DIEP

In addition to medical and professional treatments for scar management after DIEP surgery, there are several natural remedies that you can consider. These are generally more accessible and can be a gentle way to support your skin’s healing. Here, we’ll focus on the benefits of Aloe Vera, Vitamin E, and essential oils:

Aloe Vera and Vitamin E

Aloe Vera is renowned for its soothing and healing properties. It’s often recommended for a variety of skin conditions, including burns and scars, because it:

• Moisturises the Skin: Aloe Vera gel is rich in water, which helps to hydrate the skin and promote an optimal healing environment.
• Reduces Inflammation: The gel contains compounds that provide a cooling effect, reducing inflammation and discomfort associated with healing wounds and scars.
• Accelerates Healing: Some studies suggest that Aloe Vera can boost collagen production during the healing process, potentially making scars less visible.

Vitamin E is another powerful natural remedy often used in scar management. It is known for:

• Enhancing Moisture: Vitamin E is an antioxidant that helps support the skin barrier’s function, keeping the skin hydrated and less prone to scarring.
• Promoting Flexibility: Regular application of Vitamin E oil can improve the elasticity of the scar tissue, making the scar less stiff and more subtle.
• Reducing Discolouration: Vitamin E can help moderate the overproduction of pigment that can occur in healing wounds, which might reduce dark spots and patches.

You can apply these remedies directly to the scar once the wound has completely healed and closed. It is important to perform a patch test first to ensure you do not have an allergic reaction.

Essential Oils for Scar Reduction

Essential oils, such as lavender, frankincense, and rosehip, are popular for their regenerative properties. They can be used to:

• Support Skin Healing: Essential oils can promote skin regeneration and might help improve the appearance of scars.
• Reduce Redness and Swelling: Some oils have anti-inflammatory properties that can soothe the skin and reduce visible redness and swelling.

Always dilute essential oils in a carrier oil like coconut oil, jojoba oil, or sweet almond oil before applying them to the skin to avoid irritation. Use them sparingly and, ideally, under the guidance of Dr Bish.

Sun Protection to Reduce Scars after DIEP

Protecting your scars from the sun is critical, especially in the months following surgery, as scars are more susceptible to sun damage, which can make them more noticeable.

Choosing the Right Sunscreen

When selecting sunscreen, look for:

• Broad-Spectrum Protection: This will protect you from both UVA and UVB rays, which can damage the skin and worsen the appearance of scars.
• SPF 30 or Higher: A high SPF will provide better protection against the sun’s rays.
• Mineral Sunscreens: These contain active mineral ingredients, such as titanium dioxide or zinc oxide, which are less likely to irritate sensitive skin.

Tips for Protecting Scars from the Sun

• Apply Sunscreen Regularly: Reapply sunscreen every two hours, or more frequently if you are swimming or sweating.
• Cover Up: Wear protective clothing, such as a long-sleeved shirt and hats, to physically block the sun from your healing scars.
• Avoid Peak Sun Hours: Try to stay out of the sun during the hottest parts of the day, usually from 10 am to 4 pm.

FAQs about How to Reduce Scars after DIEP Surgery

How long should I wait after DIEP surgery before beginning scar treatment?

• It’s important to wait until your surgical wounds have fully healed before starting any targeted scar treatment. This usually means waiting until Dr Bish confirms that the incisions have closed completely and there are no signs of infection. This can take several weeks, and the exact timing can vary based on your healing rate and the specifics of your surgery.

Can massage therapy help reduce scarring after DIEP surgery?

• Yes, gentle massage can be beneficial in managing scars after they have healed. Massage helps to break down the dense bands of collagen that form in scar tissue, which can reduce rigidity and make the scar less pronounced. Always wait until Dr Soliman gives you the go-ahead before starting massage to ensure your incisions have healed properly.

Is it normal for scars to itch as they heal?

• Yes, itching is a common part of the healing process as the skin repairs itself and nerve endings heal. However, excessive itching can lead to scratching, which may worsen the appearance of scars. If itching is bothersome, discuss appropriate treatments with Dr Bish, such as the use of antihistamines or mild topical steroids.

What are the signs that my scar treatment might not be working?

• If you notice that your scars are becoming thicker, more raised, or darker over time instead of gradually improving, it might be a sign that your current scar management strategy is not effective. Persistent redness, increased pain, or swelling around the scar are also indicators that you should consult Dr Soliman to reassess your treatment plan.

Can wearing compression garments help with scar management after DIEP surgery?

• Compression garments are sometimes recommended after surgeries to help reduce swelling and support healing tissues. For DIEP surgery, wearing a compression garment can help manage abdominal scars by keeping the area flat and stable, which may prevent the scar from becoming raised or overly stretched. Always follow Dr Soliman’s recommendations regarding how long and how often to wear any compression garments.

Further Reading about DIEP Surgery with Dr Bish Soliman

• Read more about Secondary Procedures after DIEP
• Read more about Combining DIEP Flap with Other Reconstructive Techniques
• Read more about Prosthetic Nipples and Tattooing after DIEP Breast Reconstruction
• Read more about Physical Therapy and Rehabilitation after DIEP Flap Surgery
• Read more about What to Wear after DIEP Flap Reconstruction

Medical References about Scars after DIEP Surgery

• Microneedling in Abdominal Scarring after DIEP – NCBI
• DIEP Flaps in Women with Abdominal Scars – Research Gate
• Breast and abdominal scarring after DIEP – Science Direct
• (PDF) Microneedling in Abdominal Scarring after DIEP – Research Gate
• Scar Wars: Preferences in Breast Surgery – PubMed