Dr Rebecca Wyten on Breast Reduction and Scarring

Today Trish got to speak with Dr Rebecca Wyten from CocoRuby Plastic Surgery in Melbourne, about Strataderm and why it’s her product of choice for her breast reduction patients recovery and scar management.
You’ll hear Dr Wyten’s 4yo in the background having fun while mum and Trish were ‘working’. #WorkingMums #TheThingsWeDo
@cocorubyplasticsurgery @stratpharma_australia @drrebeccawyten
Transcript – Dr Rebecca Wyten on Breast Reduction and Scarring

 

Trish

Hello, listeners. It’s Trish Hammond here from the Aesthetics Uncensored podcast. And today I am joined by the wonderful Dr. Rebecca Wyten. Now Dr. Wyten is a Specialist Plastic Surgeon based in Melbourne at Coco Ruby and today we’re going to have a chat about breast reduction and using Strataderm to effectively minimise scarring after major surgery. So welcome, Dr. Wyten. 

Dr Wyten

Thank you for having me. 

Trish

Thank you so much for being here. And I know that we might get a little bit of noise in the background for me, little one, is that right? 

Dr Wyten

Yeah. So here’s a little bit of a character. 

Trish

Fantastic. That’s great. I look forward to it. Because I love little kids in the background. It’s awesome, shows that we’re still gonna live real life. Even though you work full time as a Plastic Surgeon, you still have to live a real life.

Dr Wyten

That’s what working moms do isn’t it? 

Trish

Exactly, exactly. So tell us. So you’ve been using of course, you’ve been doing breast reductions for years and you are now using Strataderm for your patients. Can you tell us like, first of all, maybe tell us some or why your Strataderm and your product of choice?

Dr Wyten

Okay, so when we started doing breast reduction surgery privately, we used a variety of different post op treatments, and management for the patients, including dressings and tapes, and additional garments. And what we found is, first of all complicated things when it came to communication with the nurses. But also, we found over time, more and more patients, we get developing reactions to adhesive tapes and those reactions were becoming 

quite extensive in nature throughout the whole breast so it actually impeded on some of the patient’s healing processes. So I was introduced to silicone ointment quite early on in my practice, and we found that the silicone ointment was probably the least irritating of treatments, it was easy to use, it was very easy to communicate, because we kept it to one sort of dressing management skill and the patients didn’t have any problems with it. And it also taught them how to be in charge of their wounds so it was a great starting point for wound management and then progressively over time, we’ve found that the silicone ointments have really helped with the maturing development and scar management of our patients over time. 

Trish

Yeah, right. And do you find that because I am one of those people that’s allergic to the tape, I can eat sharp and swell up like a balloon or I don’t even understand why. So of course, I’m a real advocate for silicone as well. But with you, when you’re talking about scars with your patients, like what advice do you give them? Like how do you get them to comply?

Dr Wyten

I guess, I think the majority of time it’s about information. The more information a patient has, the more comfortable they are with their wounds, and the more reassured they are with how they’re progressing. So even before we do the surgery, we talk about scar management and scar management really is in three basic periods. So the first period is really the immediate post op, where they’re dealing with a wound that is healing,  and is very roaring in nature and it’s about just topical treatment Stratamed at that point, which is a lovely, mild light silicone ointment. Then we talk about progressing around the three month mark where you lay down a majority of your scar tissue and because you’re laying down a majority of scar tissue, your scar will thicken and red and it’s about informing those patients preoperatively what to expect. And at that point, it’s really important to then introduce the Strataderm because then the Strataderm is a thicker silicone ointment and then we massage it in. So it’s not only the ointment, but it’s the key to massage and touching that helps that scar to mature and then we inform patients that at the third stage around one year to two years that scar will then lighten and remodel and then it’s all about maintaining that to a moisture level. So we tell patients to use it for up to a year and then continue for that if they need to because it does sometimes take two years for a scar to fully mature so already the patient before surgery is aware of the situation. And then every step of the way we remind them of what to expect, and how to deal with their scars. 

Trish

Yeah, right. And do you find that like, because like a year sounds like a long time, but it’s some, like, wow, got all your stuff for you. But the thing is, you do want to keep your eyes on that scar, because like, I’ve had scars where I haven’t done anything with them before I became wise and with those ones, they’re like, I can see a massive difference and this, like my scars now, they actually hurt because I never on one side of my breast because I never looked after. And when I get it done, I can’t even stress how important it is to, like, you might think, oh my god a year is such a long time but it’s just a simple application, like two seconds in the morning and that’s it and it’s gonna stop. I guess that’s what happened to me, because mine’s all red and it’s really sore. Like, even sometimes I’ll sit there and it’s sore. 

Dr Wyten

Yeah, and it’s about educating the patient preoperatively as well. So, for me, part of my process is communicating in conjunction with the silicone treatment with the patients is having a really good relationship with my nurses so as the patient goes off to sleep with a lot of the breast surgery, we’ll do a block similar to ladies that have an epidural or spinal but this is in the breast area. So what we’re doing is we’re breaking their pain cycle at that point,

putting the block in so they’re more comfortable, the analgesia is less, and then introducing scar management. And by doing this scar management with the silicone treatment and the massage, what we’re doing is being tactile to the skin and the more tactile you are to the skin, the more touching and the feeling, and the message you’re retraining your brain, so you don’t develop those chronic pain cycles that some people have so not only is scar management involved in the scar, but it’s also involving minimising any chance of chronic, sharp, irritated pain in the future. So it’s really important from that day, that we inform the patients on how to do that because really, an operation is not just the operation, the procedure is not just the operation, but it’s actually the preoperative care, the intra operative care and the post operative care that’s really important in order to get the best possible result because in the end, the patient will be looking at the scars and how they feel. 

Trish

Yep, you know, you’re so right, because I know it might sound ridiculous, but my scars are 11 years old now on my breast, and they still cause me pain from lack of adhering to my postdoc regime that the Doctor gave me. I was like, oh, yeah, now I’m fine and so, like, that’s so important to listen to you. 

Dr Wyten

Yeah, I think the other thing is also informing patients, you know, different pigments, skin reacts differently to scars. So the darker the pigment your skin, the more chance you are of what’s called hypertrophic or keloid scarring, where your body really sort of over scars. So it’s a pathological process and it’s about recognising that before going into surgery, and treating it as early as possible, after surgery, in conjunction with the silicone ointments, we also are very fortunate at Coco Ruby to have dermal therapists who do laser treatment and also use kenacort with Derma pen treatment, so a steroid as well, in order to dampen down that great inflammatory response that some people have with scars. And in that way, we can get the best possible scars on our patients. 

Trish

Yeah, right. And when you’re doing breast reductions, there’s not just like, like, where is the ointment port? Like sorry, not only my women there from where the Strataderm port likes because you do run the nipple as well, don’t you? 

Dr Wyten

Oh, correct. So it varies on the operation. You know, I do a variety of things either do fat transfer where it’s small little puncture marks, or I do breast reductions of breast lifts where the scar is around the areola or sometimes in the fold of the breast, the IMF inframammary fold, we call it and so it varies from person to person where their scars are, and what’s required. The bigger the lift or the bigger the reduction, the larger the amount of scars are required because the more skin that’s needed to be excised. So, generally the larger scars you can have around the areola in the inframammary fold, which is the breast fold and it can even extend towards the side in towards the axilla or under the arm so they can be quite extensive. We also tell patients in conjunction with Strataderm or Stratamed or any other silicone ointment, it’s really important not to irritate those areas. So I tell the majority of my patients to try and avoid any underwire bras for the first year as well and just use it a softer bra, even when it’s still supportive, but a band around the bottom of the breast is a little bit better than something that’s sitting and pressing up against the bra line and also using bra wear that absorbs moisture rather than continual sweaty environment, which also can irritate scarf. 

Trish

Yeah, yeah. And I just wanted to ask you about it. You talked about the progressing three month mark, when you’re talking about the three different stages of scarring. Yes, with the progressing, three month mark, is that, like, is that probably the most important time like, because I know that like, when it first happens, you don’t want to even touch anywhere on your body, like I never do want to touch and it freaks me out to sort of touch a scar. But after three months, everything’s kind of looks like it’s healed, it just kind of might be angry looking or whatever. So is that like the most important time or I guess it’s probably important the whole way through?

Dr Wyten

Yeah, so basically, between that sort of post operative period of three months, your body’s laying down a lot of scar tissue in a random pattern. So it’s just laying as much tissue down to try and help you heal. So it does become so at that point, we’re kind of involved in touching gently, just so your body gets used to the touch and as you feel more comfortable, you can be a little bit more aggressive. So what we’re saying is the first couple of weeks, so basically, the first four weeks, just be gentle and then you can be a bit more firm with your massage up to the three month mark. Then after the three month mark, the body then starts to remodel that scar tissue into a more grid like fashion and that’s when massage is a real key as well so that it stops tethering of scars so the scars don’t be tethered to the underlying structures. So it’s, it’s all about just informing the patient, but also making sure they’re comfortable doing it as well. 

Trish

Yeah, yeah. Well, that’s true, because, like, I probably wouldn’t be comfortable with that.

But yeah, and I guess if we doctors are different, too, because some suggest one way and some suggest another so it’s what you’re always suggesting that works for you and other people may suggest what works for them. Is that right? There’s not one hard rule for everybody, is there? 

Dr Wyten

Well, I mean, based on studies looking at chronic pain, if you talk to a therapist or physiotherapist, when it comes and also a dermal therapist, scar management is involved with a tactile taught treatment so it’s really important to be able to do that early, even if it’s just gentle touch. But you know, with a lot of chronic pain patients, especially in hand therapy, they use a variety of different tactile sensations in order to retrain the brain that it’s okay to touch. Because what you don’t want is your body to suddenly go, Oh, that hurts, then not touch it. And then the next time you touch it again, oh, it hurts anymore, and your brain then tells you it hurts again so it starts that vicious cycle of chronic pain. So basically what physiotherapists do, and how therapists do is retrain the brain with different sensations such as, you know, human touch, you can use Velcro, you can use Phelps, you can use feathers, you can use rice, anything that really changes that tactile sensation, will retrain the brain so it’s okay to touch because what we don’t want to do is get into that chronic pain cycle, because then that changes the skin qualities as well over time. 

Trish

Yeah, right. And what do you do? Or what do you tell patients who don’t actually stick to your post op regime?

Dr Wyten

We keep a close eye on them, first of all.

Trish

You don’t let them not stick to it.

Dr Wyten

I think it’s with our patients, we sort of see them at the one week for two weeks, around this sort of six to eight week mark, three months, six months, nine months and yearly after that.

If we are concerned that the patient is hesitant, or that they are laying down a lot more scar tissue than other people, then we will reinstate them with our dermal therapists early. So it’s about just a little bit more hands-on teaching, rather than just letting them do it themselves. So a majority of the patients that are a little bit hesitant at first, it’s just about just giving them a little bit of reassurance and telling them that you know, it’ll be okay and if we continue with touching and massage that they’ll hit in the right direction. 

Trish

And with the Surgeon can you just run through like how a patient would use it so like, you only use it once a day or could you use it more than once a day. 

Dr Wyten

Now we tend to use it twice a day. And we tend to just apply it gently to the wound itself, the area and it’s just a light application. It’s not thick at all, and it glides on quite easily and so that’s really, you know, the Stratamed, which is a very light application that can be done in the first six weeks or six weeks and then once the scar is mature enough, then you can start to introduce Strataderm which is a little bit thicker, as well and that works really well. And then you can start to sort of massage it as well. So I say to patients, apply it in the morning after shower, have breakfast, but sit there and just massage it while you’re having breakfast.

And then in the evening, you know before you go to bed, it doesn’t really matter. There’s no hard and fast rule. We also use Stratpharma qualities or brands for pre op patients as well. So for a patient that’s having a breast augmentation, I’ll use a thicker silicone ointment from the Strata area to apply to the breast preoperatively to just soften the skin as well. Yeah, and a lot of the time, I think there’s a section within the Strata. There StrataXRT, which is used for radiotherapy patients, I’ve had a lot of friends that have undergone radiotherapy. for cancer treatment where we put the strata XR in the fridge. And after the radiotherapy treatment, we put the StrataXRT on their skin, which helps relieve their skin and soothe them as well. It’s very, very soothing and it really helps that, especially if the radiotherapy is too deep in the structure, the skin gets affected quite poorly. And then we use the Stratamark, I think is the pregnancy base one which can be used on the tummy or the breast and we tend to use that one preoperatively if we think that the patient needs it, if they’re having a breast augmentation in there, they’re acquiring a larger size and we want to sort of make sure that skins very supple prior to doing that. So there is another whole sector of this area that we can utilise it for as well.

Trish

And so that’s mainly to soften it pre surgery so that is because I guess if it is softer, when you’re cutting, it’s going to help it just make sense. 

Dr Wyten

Yeah, well, when you’re doing a breast augmentation, you’re stretching the skin so like with anything like with pregnancy, a sudden onset of stretching of the skin can lead to stretch marks so by letting that skin be as subtle as possible, genetics does play a part in it, but by making it as simple as possible that can assist in minimising stretch marks so I was very fortunate with my pregnancy that I used the Strata ointment throughout my pregnancy and you know, genetics does play a part, but I was very lucky that I was able to avoid any stretch marks so that was also a benefit. 

Trish

Yeah, mind made up for yours. That’s okay. It’s a yin yang mind made up for yours.

Dr Wyten

Oh, look, it’s a good tribal scar, isn’t it to show that we’ve been through a lot. 

Trish

Exactly. It’s my war wound. Exactly. Yeah, but I was gonna say so on that because it does. Um, so Strataderm is good for all types of scars, which includes the old and new scars as well so you can actually put it on an old scar. Hey,

Dr Wyten  

Yeah, we don’t introduce it. I think it’s best work is with new scars, as it’s maturing.

It’s to do with, I think a combination of having that subtlety to be able to massage in combination. What’s lovely about the silicone is it sort of rolls on quite nicely. It’s quite a nice texture so it assists with massage whereas some ointments, you find once you’ve rubbed it on it absorbs it and it’s sort of dry again. So I think, if you want to continue with a bit of scar management, silicon is quite nice to utilise.

Trish  

Awesome, and I was gonna ask you one more thing. What about other people that like I’m a bad itcher? And like, how does it work for that? Because like I’ll have I don’t know why I’m just an itcher. I’m allergic and I’m an itcher. I’ve got the worst and I scar badly. 

Dr Wyten

Right. So I think some people are obviously more prone to it. Some people are a little bit more sensitive with their skin.

Unknown Speaker  24:30  

Especially dry skin can sometimes be, so some people are definitely more sensitive whether or not they’ve got dry skin and their skin hasn’t got enough barrier you know, asking that it has lovely oil on it naturally and the dry skin tends to be a little bit more irritable. You know some people have psoriasis or eczema and some people do scar poorly. So it does depend on person to person, if we know someone is a bit more hypersensitive, when it comes to scars, the first thing we do is a patch test. So instead of just pouring silicone or pouring any cream or or any dressing on, put a small little patch for 24 hours and make sure that that person is not going to react to it and if there is any reaction, then we stop absolutely everything. And we just say, well, everything’s off the table, you can’t utilise anything so it’s rare. Sometimes we do have to use a combination of antihistamines, and occasionally some oral steroids for those people that are really hyper reactive but that is rare circumstances. 

Trish

Yep. Well, that makes a lot of sense. Because mind you, I’ve never heard of an analogy to silicone. But you just, I guess you just don’t know. Hey,

Dr Wyten

I think it’s important to be sensible as well, the thing is, if someone’s already reacted to something, it doesn’t really matter what you’re going to put on it, you’ve got to be careful, that’s just not going to aggravate it. So we find those patients that are sort of allergic to tapes, or have had a reaction to tapes, then what we potentially do is wait until that settles and then apply something new rather than adding on top and then potentially causing a new sensitivity immediately post up after the surgery, I actually use a silicone dressing, because I found that is less aggressive and irritating than any other adhesive so now I use a silicone dressing and then after that first week that comes off, and that’s when the the ointment starts. So I found that’s a really good protocol for me, everyone is different. Everyone has a protocol that works well for them. But I found that protocol works really well for me, and the patients are having less reactions. 

Trish

And do you think and like just just for the people that might be listening and they think, Oh, I wish I looked after my scar or I still got a lot of scarring or do you think it’s okay to start something like this, like years down the track? Okay, I want to actually look at getting the scar fix now. 

Dr Wyten

Yeah, so when it comes to scar revisions, you know, there’s basic scar revisions where you could just attempt massage and silicone treatment. There’s potential scar treatments where you go, Okay, well, maybe we exercise this because it was in an aggravated environment. And maybe we should excise this and try the silicone treatment or dermal therapy afterwards. A more aggressive treatment for those patients with keloid or hypertrophic scarring is that I work in conjunction with the Radio therapist, Peter Mac so those people that have very aggressive keloid scarring, we’re using combination of excising the scar, and then using radiotherapy in conjunction, which is a very, very light dose of radiotherapy, which actually minimises the body’s inflammatory response and minimises scarring. So that’s really the last attempt method for those patients that have very severe Hypertrophic or keloid scarring and then which is more.

Trish

And then you start on the side of them and just go through the one year was, yeah, okay. Okay. Yeah. 

Dr Wyten

Yeah. So it varies from person to person, obviously, it depends on how severe the scarring is, what treatment they’ve had in the past, what their history has had so patients sometimes have a thicken scar because they’ve had a history of infection or irritation during the time of healing. So then you say, well, maybe it’s worthwhile to excise that scar and attempt it in a different environment or, with those patients that have a darker skin pigment more common in African Asian descent patients with pigments very thick and they have a family history of keloid scarring that’s when you say, well, we know that you have a family history, and it’s probably important to consider having a referral to the radio therapists if required.

Trish

Okay, look, that’s been so interesting because it’s like, I talk about scars with people all the time and I know that like Strataderm is just something else and I’ve seen the before and afters but it was good to hear you talk about the Stratamark and the StrataXRT I think it’s called because yes, yeah, cuz you just like there is a great range that to choose from as well for all of your and I’ve seen phenomenal results with that Stratamark for pregnancy I mean, mind blowing, I’ve just been like, whoa, and yes, my friend’s daughter who’s somebody, she’s 14 now and all of a sudden her boobs are just gone. Like what? And she’s got massive red scars on the side, like they’re really raw like these boobs have grown really quickly kind of scars and she’s using it now and after a short time, like she’s noticed a difference so there’s a great range of products there. 

Dr Wyten

I think it’s very common now, girls decide to develop and develop quite largely quite early in their puberty. And we are getting a lot more referrals for breast reductions in younger women. And they are getting a sudden influx of volume very quickly over the development, which is very self conscious for them. But also, those stretch marks are quite aggressive so a combination of silicone treatment and or do early dermal therapist referral actually, because the dermal therapist when stretch marks or red can do remarkable job at correcting and maturing stretch marks so it’s important to see whether whether or not you know, your local Dermatologist or Plastic Surgeon has done with therapists is worth reviewing those scars to see whether or not silicone and in conjunction with silicone and dermal therapy, such as laser or Derma pen treatment may assist with maturing those scars and preventing the stretch marks as well progressing. 

Trish

Yep. And I love that, like that at your clinic, everyone is really focused on the scar as its own thing as well, you know what I mean like that, because I’ve spoken to people all the time where there’s had their surgery go away, and no one even talks about the scar, whereas the scar is almost another procedure in itself for you guys. I love that because it does matter for a lot of people, it doesn’t matter what the scars gonna look like.

Dr Wyten

I think it’s important because really, you know, in the end, the operation, like I said before, is only part of the process. Yeah. And the post operative care is almost just as important. The team postoperatively and the management of the patient postoperatively really sort of provides that patient experience that the patients remember and then when they look in the mirror every day for the rest of their life, they will see these scars. Now, if we can mature them enough. We have patients where from standing point you can’t see their scars anymore and so it does make a huge difference to their self esteem. And also, they have to be comfortable with them long term so if we can make them as best as possible, then that’s really just the icing on the cake. 

Trish

Yeah, yeah. Amazing. Look, he’s quiet now. Now that we’ve finished he’s quiet.

I love it. I love it. 

Dr Wyten

I’m sorry about that. 

Trish

That’s fine. Thank you so much for taking that like, this is your personal time and you’ve taken the time to speak to us on this podcast. I really, really, really appreciate it. 

Dr Wyten

Oh, my pleasure. Anytime.

Trish

Lovely. Oh well listeners look if you do want to check out Dr. Rebecca Wyten and as I said she’s at Coco Ruby Plastic Surgery. She does beautiful breasts as well so you can check out all of her pictures online. And yeah, so Google or you can send a DM to us as well, we’ll put you through so thank you so much for joining us today Dr. Wyten. 

Dr Wyten

Absolute pleasure. Thank you for having me. 

Trish

Thank you. Bye bye. 

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Well, like all good quickies it's time to dust off and get back to our day jobs! If you liked the podcast please rate us because we need the validation for our fragile hearts. If you have a story to share or have a burning question you would like us to cover please slide into our DM’s on Instagram at @transformingbodiespodcast. Stay positive, keep your boobs and chins high until we chat again xoxo Trish