Why Anastacia’s scar ripped so long after cancer surgery
. . . and what you need to know to make sure it doesn’t happen to you
Anastacia may have earned her place on strictly come Dancing by being a chart-topping pop star, but it’s her health that’s been making headlines. the 48-year-old — who had a double mastectomy in 2013 after having breast cancer for a second time — had to pull out of a dance-off because she had ‘ripped’ her mastectomy scars during training and feared she would be going home for further surgery.
scans have since revealed that there was no permanent damage — but the singer’s experience shows that scarred skin is never quite the same and can be vulnerable to rupture.
‘When deep wounds heal, skin and the underlying muscle is never again at full strength,’ says Justine Hextall, a consultant dermatologist at Western sussex Hospitals NHS trust. ‘it is less elastic, weaker and may be prone to tearing when stretched.’
‘Patients with scars must be aware that there will be a lifelong vulnerability. Just because skin has healed, doesn’t mean it stretches.
‘scarred skin will be 80 per cent of its previous strength.’
However, Dr Hextall says that, fortunately, scars don’t usually rupture years later — generally, if a wound reopens (known as ‘wound dehiscence’), it tends to do so in the first few weeks after surgery while it is still healing.
areas where the skin is stretched, such as the chest and back, are most at risk.
she suggests patients ease themselves back into exercise and look out for symptoms such as pain or a feeling of the skin stretching — stopping immediately should they occur.
scars are formed when the deeper layer of skin, known as the dermis, is damaged — the dermis contains collagen, a protein, and connective tissue.
the dermis activates a repair response that leads to collagen being produced. (shallow nicks don’t scar because the top layer of skin, the epidermis, doesn’t contain collagen).
normally collagen fibres are laid down in a neat, criss-cross pattern, but sometimes the repair process goes haywire, producing too much collagen, which leads to big bundles of the protein being laid down incorrectly, causing scars.
around one in three of us have a scar of some sort and many find them upsetting, with two-thirds of people affected saying that their scars impact their lives, according to Jo Hemmings, a behavioural psychologist based in London.
But there is much that can be done to minimise their appearance (though many treatments are available only privately, as scars are seen as a cosmetic issue, even if they are the result of a very real medical problem).
the two most common types of scar are keloid and hypertrophic. Keloid scars develop when collagen spills out beyond the injury site, creating large, lumpy scars that can grow.
they’re more common in darker skin and tend to form on the chest, shoulder and back.
Hypertrophic scars — common after surgery, acne or burns — stay within the confines of the injury site, but can also be hard and red.
standard treatment includes silicone gel, thought to help the skin retain moisture and boost healing. another option is steroid creams or injections, which break down the collagen bundles. Lasers are widely used, too.
Pulse dye lasers reduce redness — they contain a coloured dye that helps direct a beam of light that’s absorbed by blood vessels in the scar. as they absorb the light, the blood vessels heat up and are destroyed. Resurfacing lasers penetrate deeper to burn away excess collagen and reorganise the fibres.
‘there are many types of lasers out there, but the strongest of these resurfacing lasers are the fractionated ERBIUM-YAG laser or a cO2 laser,’ says Dr anjali Mahto of the British association of Dermatologists.
‘Others, even supposedly newer models, simply aren’t strong enough and penetrate only the upper layers of skin, which has no effect on collagen.’
another option is microneedling, where tiny needles puncture the skin to stimulate the repair system afresh.
BLOOD INJECTIONS
THERE are even more cuttingedge treatments available — for example, a gel made from a patient’s blood and then injected back into their skin is thought to help reduce scarring.
the treatment is based on platelet-rich plasma (PRP) therapy — a sample of blood is taken and spun to separate its components, including plasma.
the plasma, containing substances that aid cell growth and healing, is injected around the problem area. it has been used to treat tendon injuries, baldness and burns with promising results.
Dr Daniel sister, a cosmetic dermatologist in London, has pioneered the technique for skin conditions and says it has advantages over conventional treatments.
‘PRP in scar treatment is based on the idea that spinning blood will help extract growth factors that help to reboot the body’s repair system,’ he says.
‘this is slightly different from how it works in other conditions such as tendon injuries where the growth factors directly help regenerate the tissue.
‘it seems that PRP works differently depending on where it is injected.’
PRP works in a similar way to microneedling. ‘i can see how it would be an effective treatment, given i’ve had success with micro-needling, but more studies would be helpful,’ says Dr Hextall.
BLAST OF CO2
AS WELL as using cO2 lasers, doctors are injecting the gas around the scar. the theory is that injecting cO2 into tissues alerts the brain that a certain area is low in oxygen — the body responds by delivering extra oxygen-rich blood containing cells and nutrients that help wound healing and tissue regeneration.
‘this can be done on fresh and old scars and could be better than lasers, which can be used only on old scars,’ says Dr sister.
Dr Hextall says: ‘this would be good for acne scarring where skin is pitted and would benefit from a collagen boost.’
SPRAY-ON SKIN
IT SOUNDS like the stuff of sci-fi, but a company has developed a spray-on skin treatment that improves healing in burns and the appearance of scars. the Recell spray On skin system takes a small sample of healthy skin from the patient and uses an enzyme to break it down so it can be put in a solution. a surgeon uses a laser to soften the scar, then it is sprayed and dressed — the idea is that the solution will stimulate the replication of new skin that helps fade scars.
BOTOX INJECTIONS
INSULIN may also repair scars. in a trial at the Queen Victoria Hospital in east Grinstead, West sussex, and imperial college London, women undergoing breast surgery will have the hormone insulin or a placebo injected near the wound site, and then be monitored for 12 months.
the theory is that insulin interferes with collagen production and reduces scarring.
another injectable treatment is Botox. some dermatologists use it to prevent and treat scars as it reduces ‘tensile forces’ in skin, which gives it the best chance of healing properly.
STEM CELL JAB
scientists believe they can ‘re-programme’ adult cells to behave like stem cells (which can turn into a variety of cell types), by exposing them to different chemicals and fiddling with the genes they express.
‘Despite the lack of real trials for stem cell therapy in scars, it is becoming increasingly easier as more doctors have access to it,’ says Dr sister. injecting it into already developed scars has produced some brilliant results, he says, drawing on his patients.
a small sample is taken from the top layer of skin that contains stem cells. these are processed for half an hour in a lab before being injected into the patient’s dermis.
the idea is that they regenerate damaged tissue and replace the scarred areas.
BETTER DRESSINGS
DRESSINGS can play a major part in wound healing and scarring. Research suggests silicone can encourage the healing process.
now a dressing containing silicone has been developed to reduce surgical scars. it is applied immediately after stitches are removed and wraps around like a standard bandage. it is designed to be tight, gently pulling surrounding tissue towards the wound, reducing tension in the stitched areas.
in a u.s. study, women who’d had tummy tucks and had the new dressing afterwards experienced significantly less scarring compared to a group left to heal naturally, according to a study in the annals of surgery in 2011.
Larger studies are planned.