About post-surgical scars
Around 60% of people with cancer will have surgery as part of their treatment plan. Advice about how to manage your scar in the short, medium and long-term should be given after any surgery. Unfortunately, scar management support and advice can be very hit and miss depending on when, where and the circumstances in which you have your surgery.
Scars will heal superficially within 4-8 weeks after surgery. Once there are no open areas and scabs, a scar will be considered healed, however the full process of scar healing and remodelling can take up to 18-24 months. After this time, a scar will be considered ‘mature’.
Why is scar care important?
It is very important to start self-massage, once your scar has superficially healed, unless advised otherwise by your medical team (for example if you have surgical mesh or within 2 weeks of radiotherapy). This will encourage the best possible healing for the layers of soft tissue affected by your surgery.
Touching your scar is also important for stimulating and encouraging the repair of nerve endings that were damaged during surgery, which can help to reduce hyper-sensivity and pain.
As well as the physiological benefits of scar massage, touching your scars can help with the psychological and emotional impacts of cancer and surgery. It can help you familiarise yourself with your new appearance and have a positive impact on your relationship with your body and image.
I completed my Oncology Scar Specialist Training with Restore Scar Therapy and I incorporate these techniques into all my clients’ post-surgical rehabilitation plans.
How can I look after my scar?
There are several aspects of scar management, including: moisturising, use of barrier gels or sheets and scar massage.
Moisturising:
Once your scar is fully healed over (no scabs or open areas), you can start to apply a plain, unperfumed moisturiser 2-3 times daily to the scar and surrounding skin. It is also important to remain hydrated and drink plenty of water/fluids throughout the healing process. It is also essential to apply SPF to scars that will be exposed to sun as they are more vulnerable to sun damage. You should continue with this for up to 2 years, after which the scar will be considered ‘mature’.
Barrier gels or sheets:
Using a barrier cream, gel or sheet is an important element of scar care, to encourage a neutral, flat appearance and prevent the formation of keloid (raised and extended beyond original scar site) or hypertrophic (raised within original scar site) scars.
Silicone is the best product supported by research, to seal moisture into a scar. It comes in the form of gel (which can be reapplied during the day) or sheets (which can be worn all day and reused for several weeks). It is recommended to use silicone on your scar for at least 90 days.
Scar massage:
As mentioned, scar massage can have physiological, psychological and emotional benefits following surgery. The main aims of scar massage are to improve flexibility and mobility of a scar and the surrounding soft tissue and joints. Other potential aims are to reduce pain and hypersensitivity, or to stimulate a numb area.
Try the following techniques, in order to those applicable to you, gradually building up to 5 minutes 2-3 times a day, for at least 6 months after surgery. Remember that the more recent your surgery, the more responsive your scar will be to these techniques, so be gentle and revert to more superficial techniques if your pain increases.
1) Light touch: using light pressure from your fingertips (the same as over your eyelid), work in all directions over and around the scar, paying attention to how much the skin moves and areas with more adhesion. Imagine trying to lightly get the skin to glide over the soft tissue beneath it.
2) Depress and release: using slightly firmer pressure from your fingertips or a flat hand, gently press into the skin, then release the pressure. Repeat this over your scar (if comfortable), around the edge of your scar (a if trying to ‘blend the scar into your skin’) and to the skin surrounding your scar.
3) Sink and twist: using one or two hands, gently press into the skin using fingertips or flat hand and rotate towards the scar imagining a ‘twist’ movement. You may do this towards or away from the scar, depending on what is comfortable.
4) Sink and roll: using one or two hands, create a ‘rolling’ movement by rocking through flat fingers towards or away from the scar. Start with your index finger and roll through a flat hand to your little finger, or try the reverse. You may experiment with the direction depending on your areas of tightness.
5) Long fibre: using two fingers or soft knuckles, work along the length of the scar in opposite directions imagining you are ‘stretching’ the scar length ways. If your scar is very tight, focus on the end of the scar and work inwards as able.
6) Cross fibre: using two fingers or soft knuckles, work inwards across the length of the scar. Place your fingertips either side of the scar then push them in opposite directions across the scar, so each fingertip ends up on the opposite side.
7) Brushing: using a softly closed fist, use your knuckles to gently brush along your scar to stimulate blood flow and nerve stimulation. This technique is best for those with numbness and not for those who have pain and hypersensitivity in the area.
If you have any concerns about scar therapy, ask your nursing or medical team. For further advice, or to learn about scar therapy in more detail, please get in contact with me at hannah@strongerthan.co.uk. For those looking for face-to-face scar tissue therapy, visit restoretherapy.co.uk for more information or to apply for free scar therapy at their workshops!