Indexing Title: RJOSON’s Medical Anecdotal Report [04-5]

MAR Title: Keloid in Mastectomy Scars

Date of Medical Observation: August 28, 2004

Narration:

A 40-year-old female came to my clinic for complaint of keloid on her mastectomy scar.

Three years ago, she had a total mastectomy using a transverse elliptical incision.

At this time of consultation, I noticed that the part of the mastectomy scar near the sternal area was prominently elevated and thickened to a degree that it had a pattern of hypertrophy and starting keloid formation.  This area spanned about 1 inch. The rest of the transverse mastectomy scar spanning from the costochondral junction to the anterior axillary line was flat and linear. 

I advised the patient on the identity or diagnosis of her problem, which was a hypertrophic scar with starting keloid formation.  I explained to her two essential things.  One, there are persons more prone to hypertrophic scar and keloids than others and the sternal areas are also more prone to these phenomena compared to other areas.  Second, there is not much we can do for the hypertrophic scar and keloids once they have developed.  Radiation, surgery, and steroid injection and topical solution have been tried before with little success. 

My parting advice, which she reluctantly accepted, was to try as much as possible to avoid irritation on the scar, especially that part on the sternal area, and to pray and hope that the hypertrophy will not progress further to a frank and debilitating keloid.  I promise her I will do some researching as soon as possible to see if there are already effective methods of treating the keloid.

Insights (PHYSICAL, psychosocial, ethical) / (Discovery, STIMULUS, REINFORCEMENT):

Reinforcement:

This is not the first time that I have encountered patients with hypertrophy and keloid formation on their mastectomy scars.  Most of the hypertrophy and keloid formation occurred on incisions that encroach on the sternal areas. Between a vertical and a transverse mastectomy scar, the incidence of hypertrophy and keloid formation is more common in the latter.  Several years ago, I started collecting data on this health problem.  Roughly, from my data collection, about 20% of transverse mastectomy scars will have