C Section Scars: Incision Types (Pictures), Prevention, And Removal

Surgeries

C section scars have an impact on over 1 million women per year in United States. The procedure is currently the most frequently performed major surgery in the USA so if you’re looking to learn how what your c section scars might be like, read on. You’re certainly not alone!

C Section Incisions:

Cesarean scars arise from the abdominal skin incision that is performed in one of two ways:

C Section ScarWhy It’s UsedWhen It’s Used
Vertical Midline• quickest to complete
• can enhance the surgeon’s visibility of internal structures
• emergencies
• when a hysterectomy is planned
• heavier patients
• if you’ve already had this type of c section before
Low Transverse• better cosmetic scar
• fewer healing complications
• less painful during recovery
• less risk of causing hernia
• most common choice
• elective procedures
• emergencies as well
• first pregnancy
Image showing vertical c section incision placement from bottom of belly button down to waistline
Vertical c-section scar placement
Image showing low transverse c section incision placement across middle waistline
Low transverse c-section scar placement

CESAREAN SCAR PLACEMENT DEPENDS ON WHICH TECHNIQUE IS USED

Cesarean Scar Types:

C section scars heal with the same variations as other scars. The type and quality of scar that forms is dependent on natural healing tendencies, surgical technique, and a smooth healing process. The are 4 main types of cesarean scar types:

Normal/Mature Scars

Normal, also known as mature scars, are the types of scars patients and obstetricians alike hope to see. They are visible to varying degrees, but are flat, narrow and blend well.

Normal, subtle, flat c section scar
Normal, mature vertical c-section scar

Hypertrophic Scars

Hypertrophic c section scars are thick, red, raised and often itchy scars. Happily, they generally normalize over the first year. If they persist, measures such as cortisone injections can help settle them down.

Widespread C Section Scars

Widespread c section scars are just that – wide and spread out. They tend to be flat and have relatively normal colouring so they may not pose as much of a cosmetic concern as hypertrophic or keloid scars.

Widespread flat, pale, stretched scar of the abdomen
Widespread type scar

C Section Scar Keloids

Keloids are the most dreaded types of scars. Keloids are characterized by growing far outside of the normal c section scar boundaries, are very thick, very raised, and often itchy and painful. Cesarean keloids can also be very difficult to prevent and treat. Here’s a typical example of a what a c section scar that formed a keloid looks like.

C Section Scar Adhesions

C section scars can be prone to adhesions. Adhesions are fibrous bands of scar tissue that tether the the skin inward to the deeper tissues. This can happen with cesarean scars because the incisions made through the skin and the muscle layer can heal together as a single scar unit, effectively attaching the underside of the skin to the upper layer of the muscle. Scar adhesions create a depressed, cleft-like appearance to the scar that can be cosmetically unappealing. Massage and surgical scar revision can be useful for this type of scarring.

C-section scar with adhesions that looks like a vertical tethered cleft of the skin
C Section scar showing adhesions

Do Cesarean Scars Go Away?

Many patients wonder if their scars will go away, particularly if a vertical scar is left that is more conspicuous and harder to hide. A fundamental principle when it comes to scarring is that all scars are permanent. Almost all scars fade and improve with time, but this process can easily take up to 2 years to complete. Only keloid scars fail to improve and may, in fact, worsen with time but luckily are quite uncommon. Preventative measures and treatments can augment and speed up the natural process of scar fading and improvement.

C SECTION SCAR QUALITY VARIES WIDELY AMONGST DIFFERENT PEOPLE

C-Section Scar Treatment, Prevention, Removal:

Old Scars

  • massaging the scar daily once it’s healed
  • silicone gel and silicone strip products (can improve scars that are years old)
  • cortisone injections
  • other injections such as 5-FU, verapamil, Botox, and bleomycin
  • surgical scar revisions followed by prevention measures

New Scars

  • follow all post-op instructions carefully; all healing complications can worsen scars
  • massaging the scar daily once it’s healed
  • don’t start exercising before your doctor gives the go-ahead
  • use silicone gel and silicone strip products
  • cortisone injections for non-resolving hypertrophic and keloid scars
  • other injections such as 5-FU, verapamil, Botox, and bleomycin for non-resolving hypertrophic and keloid scars

To learn more scar prevention and scar removal, take a look at our article dedicated to these topics.

Cesarean Scar Infection:

Infection is about 20 times more common after delivery with c section compared to vaginal delivery and skin infections occur in up to 5% of cases. This is because of the extensive incisions made and because the vagina and uterus harbor bacteria that can contaminate the skin incision. Infection after c section is seen more commonly in patients that are:

  • over 35 years old
  • obese
  • diabetic
  • had urinary tract infection during pregnancy
  • had premature rupture of membranes
  • developed a hematoma (blood collection in the uterus) after surgery.
  • premature delivery
  • general anesthesia
Infected cesarean scar with opening of wound
Advanced cesarean wound infection with opening of the incision

Signs And Symptoms Of Infection Include:

  • redness and warmth
  • swelling around the scar
  • increasing tenderness
  • drainage from the incision
  • opening of the skin edges
  • fever, chills, flu-like symptoms

C section scar infections most frequently develop around the 5th day after the procedure. If you are experiencing the above signs and symptoms, it is imperative that you seek medical attention.

Pain Where Your C Section Scar Is?

If you have pain where your c section scar is this can be normal, especially in the first few weeks after the procedure. Other potential causes for c-section scar pain are:

  • infection (usually occurs within first week)
  • abnormal scarring like hypertrophic and keloid scars

Seek medical attention if your pain is increasing, especially if accompanied by signs and symptoms of infection.

Conclusion:

C section scars are a concern to many millions of women worldwide. Two main types of scars can be created: vertical and lower transverse. Placement of the scars is one factor that determines overall c section scar satisfaction. The other is scar quality including it’s width, colour, and overall blending into surrounding skin. Scar quality is a challenge to anticipate even for highly experienced obstetricians because of the exceedingly complex cocktail of factors that determine an individual patient’s scar outcomes.

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