While some people scar minimally, with nothing more than a thin line, others develop visible scar tissue that can take months or even years to settle down. Among people with African, Hispanic, South Asian and sometimes Caucasian origins, large growths of non-malignant but itchy keloid scar tissue can sometimes develop up to a year after injury or surgery, although preventive measures and treatments can often minimize their occurrence.
Discuss your family history with your midwife and obstetrician, mentioning any previous problems you may have had after skin damage or operations. If you develop a thick, enlarged scar when you cut yourself, this indicates that you are likely to be what is called a keloid former. The keloid is a growth comprised of accumulated collagen produced as part of the body's natural healing process, but which extends out of the healing area and onto the surrounding skin.
Ask your obstetrician about her particular suturing techniques and materials. Nelson Awori, et al., in their chapter on keloid scars in "Primary Surgery," suggest that one cause of keloid formation is tight skin closure, such as in mattress suturing; they also advocate monofilament to multifilament suture material as it is less likely to provoke a keloid reaction or harbor bacteria. Steven P. Davison, M.D., D.D.S., et al., writing in 2006 for "Plastic and Reconstructive Surgery," believe that subcuticular suturing is even more preferable as it doesn't penetrate the epidermis.
Ask if your obstetrician would be willing to consider involving a plastic surgeon to inject triamcinolone acetate into the wound before suturing the skin, if you are a known keloid former. This steroid is widely used in plastic and reconstructive surgery when excising keloid scars, and patients undergo a course of injections that can produce good results in keloid suppression.
Discuss silicon sheeting as a possible wound dressing once your wound has healed. Many keloid formers have had success with silicon, which has been shown to reduce and flatten, and sometimes prevent, most keloids over a period of months. You should commit to daily use for effective treatment.
Take hyaluronic acid, a natural substance already present in your body, as a diet supplement. Davison, et al., note the markedly reduced presence of hyaluronic acid in keloid scar tissue, when it is usually produced in normal amounts during wound healing. You should, however, discuss this option with your obstetrician and pediatrician to confirm the latest research on its safety if you plan to take it during pregnancy, or after the birth if you plan to breastfeed.
Should a keloid begin to develop in the weeks or months following your Cesarean, ask for a referral to a plastic and reconstructive surgeon. Alternative treatments and methods are available for minimizing keloid scars, and your plastic surgeon can discuss all available options with you.
Resist the urge to scratch or disturb the scar while it is healing, to avoid stimulating the skin into producing more collagen.