Dark Skin Next to Your Vertical Scar After a Breast Lift or Reduction

A question came in from someone who noticed a dark strip of skin next to the vertical incision after a breast lift.

This unfortunately happens a decent amount of the time. Let me explain why it happens, because your surgeon may not have even been able to see that tissue at the time of your lift.

If you look at enough before-and-after photos of breast lifts and breast reductions, you will see people with a dark strip next to the vertical incision, the one that runs from the bottom of the areola down toward the fold.

Sometimes that's just post-inflammatory hyperpigmentation, the darkening that can follow any scar. (PIH has its own treatment plan.) But often it's something else:

A natural areola has a certain pigment, and then it feathers out at the edges, getting lighter and lighter.

So when we're doing surgery, sometimes the area we think is normal skin is actually where the areola is still feathering out. In the operating room, it looks like ordinary skin.

After surgery, that area is ischemic. Its blood supply is not as good as it was before surgery. And that ischemia leads to darkening of the tissue.

So it probably looked great in the operating room, and nothing looked like it was left behind. But as the weeks go on, the tissue gets darker, and the faint edge of areola that nobody could see becomes a visible strip.

Go look at before-and-afters of lifts and reductions again, and you'll often see the areola itself completely darker in the post-op pictures.

It's the same process. Ischemia can lead to pigmentation, and especially with a breast reduction, this tissue has much reduced blood flow after surgery. (When that blood supply is struggling more seriously, it's a different and more urgent problem.)

If you have a really, really large areola, it's possible your surgeon just couldn't get it all out. Taking all of it would have made things too tight, or made the shape strange. (Where the new areola sits on the breast is its own set of decisions.)

In that situation, we:

1. Get out as much as we can
2. Let you heal, and let everything stretch and settle
3. Go back and remove some later, if it's bothering you

There isn't one answer here. It really depends on what the situation was:

• Pigment in the scar itself is post-inflammatory hyperpigmentation, and it's treated like PIH anywhere else on the body
• Areola left behind on purpose, because there was simply too much of it, can be removed later once everything has healed and settled

So ask your surgeon which one you're looking at.

It isn't usually a sign that your surgeon was careless. In the operating room, that skin looked normal. (For what's normal with the scars themselves, here's what to expect from breast reduction scars.)

• A dark strip next to the vertical scar after a lift or reduction is common
• Sometimes it's post-inflammatory hyperpigmentation, but often it's leftover areola from the feathered edge, which looked like normal skin during surgery
• Reduced blood flow after surgery (ischemia) darkens that tissue over the following weeks, and the same process can darken the whole areola, especially after a reduction
• With a very large areola, some may be left behind on purpose to avoid tightness or an odd shape, and removed later once you've healed
• The fix depends on the cause, so ask your surgeon which one you have