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f you’ve been diagnosed with uterine fibroids and are considering a myomectomy, you likely have questions and concerns about the procedure and recovery. One common area of uncertainty is the scarring that can occur after a myomectomy. As you weigh your options, having the full picture of potential long-term impacts can help you make an informed decision.
A myomectomy is surgery to remove uterine fibroids while leaving the uterus in place. To get to the fibroids, the surgeon has to make incisions in the uterus itself. After the fibroids are removed, the surgeon stitches up and repairs those incisions. This leaves behind internal scarring on the uterus.
What types of scars are left after a myomectomy?
Other than the internal scarring on the uterus, there will also be some external scarring from the laparoscopic incisions used to insert cameras and instruments to see and reach the fibroids. However, those small external scars fade significantly over time. Internal uterine scarring is the main long-term concern for the impact on future fertility and pregnancy. The scar tissue can make the uterine wall less elastic and flexible, which may complicate embryo implantation and growth.
How extensive can the internal scarring be?
The number, types, and locations of uterine fibroids removed will determine how much internal uterine scarring develops. Very large or deeply embedded fibroids will require longer, deeper surgical incisions to excise. Multiple fibroids spaced throughout the uterus also mean more surgical cutting and more stitches to repair those sites. The gynecologist must weigh thoroughly removing all worrisome fibroids against judiciously cutting and sewing to minimize scars.
In some cases, only a single subserosal fibroid on the outer uterine wall requires removal, leaving a relatively small, neat surgical scar. For large or diffuse fibroids, the internal scarring can be much more extensive.
What factors influence scarring after myomectomy?
The skill and approach of your surgeon have a major impact on post-myomectomy scarring. Highly experienced gynecologists and reproductive specialists have intricate, specialized techniques to remove fibroids while preserving fertility. This includes meticulous, layered closure of the uterine wall incisions using microsutures and magnification for precision.
Personal healing ability also plays a role. Follow all post-surgical instructions faithfully, get plenty of rest, eat a balanced diet, and reduce stress to support your body’s natural healing powers. This gives you the best chance of minimal scarring. Gentle belly massage along incisions is also thought to aid in softening and decreasing scars after a myomectomy.
Steps you can take to prevent excess scarring
While some internal uterine scarring is unavoidable after a myomectomy, you want to minimize it as much as possible. Here are proactive steps you can take:
- Ask your surgeon about their scar prevention protocols: Do they use minimally invasive laparoscopy, specialized sutures, or anti-adhesion barriers? Get the details as this will give you a better understanding of what you’re dealing with.
- Follow post-op guidelines religiously: This includes resting, avoiding sex/strenuous exercise for the recommended recovery period, and taking it easy on heavy lifting (>20 lbs) for two to three months. Listen to your body and don’t overdo activity before internal healing is complete.
- Consider scar reduction supplements: Some patients report benefits from supplements like vitamin E, bromelain, and turmeric for reducing surgical scars. Ask your doctor about using them for three to six months after your procedure.
- Get a post-op follow-up sonogram after four to six months: Imaging can assess internal healing and catch any complications early. If scarring looks problematic, treatment can start quickly.
- Be patient through the healing process: It takes at least six months for visible external scars to fade and likely longer for internal uterine scarring to resolve fully. Trust your body’s innate intelligence and give yourself grace.
Some degree of scarring is expected with any uterine surgery like myomectomy. But you can empower yourself to understand the considerations, implement scar reduction strategies, find an experienced surgeon, and make fully informed decisions to get optimal results.
Featured image: Maria Bobrova/iStock
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