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Any surgery performed on the breast area, whether it is a simple tumor removal or various breast cancer surgeries, besides the surgeon needing to cure or control the disease, must also consider the aesthetic outcome of the surgery. Especially the surgical scar is considered the most important aspect, including the placement, size, length, and shape of the scar. If the surgeon does not consider the scar, it can lead to undesirable side effects from the surgery, causing the patient to suffer from avoidable or preventable complications, such as:
<ul>
<li>Unnecessary scarring</li>
<li>Scar contracture</li>
<li>Inconvenience in movement or dressing</li>
<li>Tissue puckering</li>
<li>Unsatisfactory scars that are visible every time the patient looks</li>
</ul>
<h2 style="color: #008080;">These undesirable outcomes can result from several factors, including:</h2>
<ol>
<li>Patient factors such as the quality of the skin tissue that tends to scar or contract easily</li>
<li>Treatment factors involving lack of attention to detail and careful surgical planning</li>
</ol>
Common undesirable outcomes that should be prevented or minimized can be categorized by the type of surgery. Here, they are divided into two topics based on the disease type being operated on:
1. In cases of benign tumor surgery
<ul>
<li>Unsightly scars with surrounding tissue contracture</li>
<li>Scars located in avoidable positions by proper preoperative planning, placing scars in concealed areas, or using scar-hidden surgical techniques</li>
<li style="list-style-type: none;"></li>
</ul>
Surgery without proper scar placement planning results in unattractive scars post-operation
2. In cases of breast cancer surgery
<ul>
<li>Darkened wound edges due to poor blood supply, which can be corrected by planning the incision to avoid damaging blood vessels supplying the skin, avoiding overly thin skin flaps, and appropriately determining the amount of skin removed to prevent excessive tension or looseness of the wound</li>
<li>Excess tissue or skin folds on the side of the torso causing problems when wearing bras, as this tissue constantly supports the arm. In some patients, friction can cause the wound to become irritated and red</li>
</ul>
Correction by considering the use of an oblique incision in patients with a plump body shape or excess fat on the side of the torso. This oblique incision is recommended for most patients undergoing total mastectomy, with advantages including:
<ol>
<li>It cuts the blood supply the least, reducing the risk of dark wound edges (skin edge necrosis)</li>
<li>Better removal of excess fat tissue on the side of the torso compared to a transverse incision (Stewart’s Incision)</li>
<li>Patients can raise their arms above their heads better than with other incision types because the incision runs parallel to the stretch and contraction lines of the pectoralis major muscle</li>
</ol>
<ul>
<li>Unplanned incisions result in unattractive and unimpressive scars</li>
<li>Scar contracture or dimpling is common in breast-conserving surgery because this surgery removes tissue surrounding the tumor, causing volume loss and subsequent contraction of surrounding tissue. This is more severe in patients who receive radiation therapy. It is a common problem or undesirable outcome for patients undergoing breast-conserving surgery</li>
</ul>
<h2>Methods to prevent undesirable scars</h2>
<ol>
<li>Choose appropriate scar placement – The incision approach varies depending on the tumor location in the breast. Some locations require horizontal incisions, others vertical. It is necessary to anticipate the direction of tissue contraction after healing and plan the incision to minimize contracture.</li>
<li>Use breast tissue to fill in the area where the tumor was removed. For small tumors, there is usually no problem using adjacent tissue to fill the cavity, and the wound edges can be easily sutured. For larger tumors, closing the cavity is difficult and may cause breast distortion. Adjacent breast tissue can be used to fill the cavity (Volume Displacement). If there is insufficient breast tissue, back muscle tissue can be used to fill the cavity instead (Volume Replacement). This also reduces scar contracture.</li>
<li>Use oncoplastic surgical techniques, which adapt plastic surgery methods in breast cancer surgery. This involves considering scar placement, the amount of tissue removed, using adjacent breast tissue to fill gaps, hiding scars, and considering whether the opposite breast needs reshaping to achieve symmetry after surgery.</li>
</ol>
It can be seen that good surgical planning can reduce or avoid undesirable outcomes from breast surgery, such as:
<ol>
<li>Preoperative determination of the incision line</li>
<li>Testing the patient’s arm movements to check for any restrictions</li>
<li>Defining the boundaries of breast tissue to be removed so that the tumor tissue can be completely excised without unnecessarily removing adjacent tissue, which could harm the wound</li>
</ol>
Additionally, using modern surgical techniques such as oncoplastic surgery in breast cancer operations results in better breast aesthetics than unplanned surgeries
&nbsp;
Pol. Lt. Col. Dr. Hasan Muhammad 
Specialist in <span style="background-color: rgb(255 255 255 / var(--tw-bg-opacity)); color: var(--tw-prose-body); font-family: ui-sans-serif, system-ui, -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, 'Noto Sans', sans-serif, 'Apple Color Emoji', 'Segoe UI Emoji', 'Segoe UI Symbol', 'Noto Color Emoji'; font-size: 1rem;">Surgical Oncology 
Rak Breast Center, Phyathai 1 Hospital

Surgery for any breast disease requires the doctor not only to plan the surgery to cure or control the disease but also to consider the quality of the resulting scar, including its appearance and the characteristics of the scar that may affect daily life.

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