The care and appearance of your skin and scars after radiotherapy or surgery is often a concern. The Australian Society of Plastic Surgeons explains that scar or scar tissue “is a normal part of the healing process, and occurs when the skin is cut due to injury or surgery,” but how scar tissue forms can be influenced by several factors, including the size and depth of the incision. There are also individual factors that affect scar formation such as age, ethnicity, health, fitness and nutrition, or being a smoker.
While scars are permanent, they can fade over time and there are several different ways to support post-surgery scar healing once you have approval from your surgeon. These may include:
- Support or compression garments
- Self-massage (your surgeon/team can tell you how)
- Silicone gel or tape
- Application of oil or moisturiser
- LED light therapy
- Physical therapy
If you have therapy with an allied health professional, it’s important that they are appropriately accredited and experienced. Amanda Hannaford qualified as an Osteopath in 2002 and specialises in treating breast tissue after surgery or radiotherapy. Amanda has introduced a new approach that, she says, “applies a completely new way of dealing with these tissue changes, using soft tissue techniques used by osteopaths to address other tissue restrictions. The treatments are gentle but are proving to be very effective and provide a quicker response in comparison to more conventional treatments such as laser therapy”.
A new approach to healing breast tissue and scars
Amanda had been practicing osteopathy in general practice with a particular interest in scar tissue and soft tissue trauma before she was diagnosed with breast cancer in 2019. Amanda had a double mastectomy, radiotherapy and a reconstruction. “In recovery I just applied my usual scar treatment process and my breast oncoplastic surgeon was surprised by my unusually good recovery”, she explains. Amanda started to use her technique on other women that her surgeon treated, achieving good results. They now work together at the Northern Beaches Breast Clinic where Amanda cares for breast cancer patients full-time. This includes treating post-surgery scars and scar tissue from all forms of surgery, such as lumpectomy, mastectomy, and reconstruction (like DIEP or TUG ‘own tissue’ reconstructions), as well as radiotherapy.
Amanda highlights that “scar tissue is different to normal tissue. In your normal tissue the collagen protein fibres form in a multi-directional pattern. In a scar, the fibres only run in one direction. This means that the tissue is not as elastic and pliable, and will feel tighter. It can also restrict the range of motion of the tissues and joints around it. This is perfectly normal, as the body is laying down ‘scaffolding’ to regrow tissue to ‘plug’ the hole in your skin essentially.” The techniques that Amanda uses may help with this: “the benefit is that deep scars can usually be resolved or significantly improved, which then leads to less tightness and hardness. The breast feels like soft breast tissue again which is more comfortable and less painful. It also reduces the chance of shoulder movement restriction and frees up normal thoracic mobility. This reduces the risk of developing Adhesive Capsulitis (Frozen Shoulder) post recovery.”
Amanda says that her technique is particularly effective when treating women who’ve had lumpectomy surgery, when she treats “the sometimes hard, thickened tissue which remains deep within the breast and is often left behind after the treatment process is ‘finished’. Patients are often told that only revision surgery will resolve this issue, but in fact these often resolve well with this treatment that I use.” Surgical scars can be treated from anytime 6 weeks post-op if there are no complications, with the approval of the surgeon/team. Older, more established scars can also be treated, and Amanda has helped improve the scars of women who had surgery over 20 years ago.
What can you do to help heal your scars?
“There is so much you can do to improve the healing of your scars, but the most important thing is to follow the advice of your surgeon and nurses to the letter,” Amanda says.
New scars are very delicate and need to be treated with care. “Once your scar is sealed and doing well, and your surgeon is happy with your progress, working your scar gently is very beneficial for healing. This is particularly the case after radiotherapy where the tissue is prone to contracture. Gently massaging your scar with circular motions in each direction a few times per day for a few minutes can help it heal in a more pliable way. If this is too painful, or you are unsure of what to do, you are not alone. Most women find mobilising their scars themselves is a bit overwhelming.” If you’re unsure what to do, then you can get advice from allied health professionals like Amanda who can show you how, so that you can self-massage at home.
Creams, oils and SPF
Follow your surgeon’s advice on which creams or oils you use. In Amanda’s experience preferences can vary significantly, however, gentle creams such as MoogGoo are popular. Amanda recommends brands free from chemicals or perfumes that may irritate your skin, as well as silicon gels, although she stresses “it is also important to keep this area very clean, as it is more vulnerable to infection, so use clean hands when touching this area or working with creams”. Additionally, use SPF50+ to protect the skin – not only post-surgery but in the future too.
Be gentle and don’t rush
The delicate skin of a new scar needs time to “knit”, says Amanda, who advises that you “take it gently and allow it time to heal first, approximately 6 weeks. If you overdo it, and stretch or strain the scar, this can cause what we call a hypertrophic (thicker) scar. This can become unsightly and more uncomfortable in time. Also, an infection can lead to a hypertrophic scar, so keep an eye out for areas infection such as heat, redness, or weeping/discharge from the wound and get in touch with your surgeon’s team, breast care nurse or GP should you have any concerns.”
Other treatments for scars
If your scars become problematic (raised, thickened, or adhered), other treatments may also help such as fillers, chemical peels and steroid cream or injections. This will depend upon how mature and healed your scar is, and you need to check whether these are appropriate for you. If your scar is uncomfortable, painful or you’re worried about the appearance of it and it’s not resolved through these treatments and therapies, it may be that revision surgery can help – speak to your surgeon about what options you have.
Feeling a bit more like you used to
Amanda says that helping women to “regain their soft breast once more, and have relief from pain and discomfort, and to be able to breathe and move ‘like they used to’, makes osteopathic treatment a joy. This form of care so often resolves the lumps and bumps in breasts, the unsightly imbalance of breast size and position, and associated discomfort and pain. Breasts which move, feel, and look more natural are a boost to self-confidence, and a welcome return to feeling ‘normal’ again after such a challenging time.”
Read about how lymphatic massage and LED light therapy can be used to help heal DIEP reconstruction scars
Amanda works at the Mater Hospital Kay Van Norton Centre for Wellbeing, as well as the Northern Beaches Breast Clinic
This content is brought to you in partnership with Eli Lilly Australia and developed independently by the team at Pink Hope in consultation with medical experts