Preconditioning with 1570 nm Laser before Reduction Mammoplasty in a Patient with a Predisposition for Keloid Scars: Case Report

Keloid formation remains a major challenge in high-risk surgical patients, and no standard prophylactic strategy has been established. We report the use of preoperative 1570-nm fractional non-ablative laser preconditioning as part of a multimodal scar-prevention protocol in a 24-year-old woman with symptomatic macromastia and a documented predisposition to keloid scarring. Because several surgeons had previously declined to perform reduction mammoplasty owing to her marked tendency for pathological scarring, she underwent three preoperative 1570-nm fractional laser sessions over 6 weeks before bilateral reduction mammoplasty with meticulous low-tension, multilayered closure. Beginning 14 days postoperatively, she received five adjunctive treatment sessions at 6-week intervals using combined fractional 10,600-nm and 1570-nm laser therapy, with selective intralesional triamcinolone acetonide and ultrasound-assisted delivery. Follow-up through 12 months, which was conducted by the treating physician, included serial clinical, photographic, and Vancouver Scar Scale assessments. Healing was uneventful, with no wound dehiscence, infection, pain, pruritus, or functional limitation. No postoperative keloid formation was observed, and the scars remained flat, thin, and pliable throughout follow-up. The total VSS score improved from 9 at 3 months to 1 at 12 months, representing an 88.9% reduction. The patient also reported high satisfaction with both the functional and aesthetic outcomes. This case suggests that preoperative 1570-nm laser preconditioning, when integrated with meticulous surgical technique and structured postoperative multimodal scar management, may be a feasible preventive approach in carefully selected patients at high risk for keloid formation. Prospective comparative studies are needed to clarify the incremental contribution of preconditioning within multimodal scar-prevention strategies.