Tension Sites · Recurrence · CityLink Mall
Keloids on the chest, shoulders and upper back sit on skin stretched by every breath and arm movement, and that tension keeps them growing. This page covers why acne and small wounds here so often become wide, itchy keloids, how Dr Sin Yong tells them from raised scars that will settle, and why the plan rests on injections and recurrence prevention rather than removal.
A keloid is a scar that keeps making collagen after the wound has closed, spreading into skin that was never injured. Mechanical tension is a strong driver of that process, and the upper trunk carries plenty of it.
The skin over the breastbone moves with each breath and whenever the chest muscles work; the deltoid pulls on the shoulder as the arm rises; the shoulder blades shift the upper back. Treatment here works against a force that does not stop, so these keloids behave differently from those on the face or ear. The usual triggers:
Types
On the chest, a keloid that starts at one acne spot over the breastbone tends to stretch out to each side, into a butterfly or crab-claw outline that can reach towards the collarbones. Over the shoulder, keloids are more often rounded or dumbbell-shaped nodules: firm, shiny, and pinker or darker than the skin around them. Having several at once is common.
Because the skin moves, they are more troublesome than most: itch, tenderness, burning and pulling, made worse by heat, sweat, bra straps, backpacks and seat belts.
The Decision
The first question is the border. Dr Sin Yong examines the lesions and the skin around them to see whether the raised tissue has grown past the wound that caused it. A keloid does; a hypertrophic scar does not, and that difference shapes the plan, as set out on keloids and hypertrophic scars. Active acne is looked for too, since it keeps producing new ones.
When to have it assessed. When a raised scar on the upper trunk spreads past its original spot or line; when it itches, aches or snags on clothing; or when acne on your trunk keeps leaving firm lumps. And before planned chest surgery if you have formed a keloid before, so prevention is built into the wound care.
When waiting is reasonable. A raised scar that stays inside its original line is more likely hypertrophic. These often soften and partly flatten over one to two years, and silicone and pressure may be enough.
When to refer. Surgery is considered only for selected lesions that have not responded to injections and adjuncts. It is assessed at Atelier and arranged by referral to a plastic surgeon where needed, with a tension-reducing closure and adjuvant treatment starting straight afterwards. Excision alone at a high-tension site is where recurrence is most expected, and keloids here return after surgery more often than elsewhere.
Where a keloid stops responding to the steroid, 5-fluorouracil can be combined with it, and cryotherapy can reduce small, bulky nodules. Whether either suits you, and where it would be given, is a separate discussion.
You leave with a staged, written plan covering realistic expectations and recurrence prevention.
At Atelier
At Atelier, keloid treatment for the chest and shoulders is built around a course of intralesional corticosteroid injections, each step reassessed before the next. At these sites they seldom work alone, so they are combined with:
Day To Day
Tension, rubbing and inflammation all feed these keloids:
Call the clinic if you notice increasing pain, spreading redness, pus or fever; a wound opening up in the scar; or rapid growth. Problems after treatment are covered in complication care.
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Atelier Aesthetics · Owned by AYA
1 Raffles Link, #B1-28, CityLink Mall, Singapore 039393 · +65 8023 7170
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