Rybchynskyy H.O
Department of Surgery and Vascular Surgery, P.L. Shupyk National Medical Academy of Postgraduate Education (9, Dorogozhytska St., Kyiv, 04112, Ukraine);
Choice of the treatment and prevention method for scar defects after surgeries for benign breast diseases
Abstract.
Introduction.
Nowadays there is no unique algorithmic approach to the selection of pathway for the treatment and prevention of scar defects in the mammary gland, and literature data on the impact of different scar elimination methods on the quality of life remains controversial.
Materials and methods.
A comparison of the effectiveness of therapeutic and prevention tactics in three groups of patients (104 people in total) with scar defects (SD) of mammary glands not related to oncology was performed. The study groups consisted of one group (33 patients) who received a non-invasive treatment of the defect scar with a solution of corticosteroid and anesthetic as well as the use of a patch and compression (in case scar width did not exceed 2 mm above the skin level) and the second group with 36 patients who underwent a combined surgical scar excision with the injection of corticosteroid with anesthetic in the base of fresh cicatrix – under the scar area along with patch and compression application. The comparison group consisted of 35 patients who were treated only surgically. The control examinations were performed on the 3rd week after the intervention, after 4 and 5 weeks, after 3, 6, 9 and 12 months, respectively.
Results.
After the application of surgical excision of scar defects, the number of hypertrophic scars decreased by 70%, and keloid scars – by one third. However, after the use of the complex treatment method, a complete regression of hypertrophic and keloid defective scars was observed, and a cohort of patients with hypothrophic and normotrophic scars arose. Histological examination revealed that the occurrence of keloid and hypertrophic scars was significantly different in patients who had a tendency towards them, which was manifested by excessive deposition of type II and VII collagen. A combined approach improved the treatment outcomes and prevented the recurrence of defective scars.
Conclusions.
A combined use of corticosteroids, silicone patch and compression in surgical or minimally invasive treatment of scar defects on the mammary gland significantly improves the treatment results, prevents relapse of such defects and reduces the timing of the scar maturation.
Key words: mammary gland scar defects, keloid scar, hypertrophic scar, recurrence.