Never Mind the Quality, Feel the Width

[helvella]

Mostly, when I post abstracts, I use the exact title of the paper as the subject. This time, I couldn't resist breaking from that.

If we try to consider the specific subject of the paper - the scar - I'd be interested to see your opinions.

Not having had any operations, other than dental, I am the worst-placed to judge, but it seems quite reasonable to care more about the width, prominence and staining than length.

Laryngorhinootologie. 2019 May 16. doi: 10.1055/a-0891-0961. [Epub ahead of print]

[Patient satisfaction after thyroidectomy - the width of the scar is more important than the length].

[Article in German; Abstract available in German from the publisher]

von Heesen M1,2, Pawlik K1, Scherber PR1, Schuld J1,3.

Author information

Abstract

in English, German

OBJECTIVE:

To avoid a scar on the neck, alternative methods of thyroidectomy have been developed. The aim of our study was to determine the significance of the scar and the factors influencing satisfaction after classical thyroidectomy in the long term.

MATERIAL AND METHODS:

228 patients who underwent partial or total thyroidectomy for benign thyroid disease between 2001 and 2014 participated in a telephone interview. In addition to patient satisfaction, demographic data, the subjective appearance of the scar, and subjective complaints were recorded.

RESULTS:

93.8 % of the patients were satisfied with the treatment. Female and younger patients tended to be more dissatisfied than both male and older patients. The mean scar length was 6.03 ± 2.36 cm and the mean scar width was 2.01 ± 1.46 mm. The length of the scar did not affect satisfaction. In contrast, patients with a wider prominent or conspicuously stained scar were significantly more dissatisfied. Patients who suffered from symptoms such as pressure or difficulty swallowing postoperatively were also significantly more dissatisfied. Cosmetic problems affect satisfaction more than functional problems.

CONCLUSIONS:

Satisfaction after thyroidectomy is good in the long term. Whether satisfaction can be further improved by using an alternative or minimally invasive procedure is questionable. These procedures may be an alternative for younger and female patients or those who focuses on cosmetics.

Georg Thieme Verlag KG Stuttgart · New York.

PMID: 31096269

DOI: 10.1055/a-0891-0961

ncbi.nlm.nih.gov/pubmed/310...

[Greekchick]

Hi helvella,

In North America, the thyroid surgeons use plastic surgery closings for all thyroidectomies. Knowing that, I wasn’t at all worried about the thickness because I knew my surgeon would be using a plastic surgery technique and the incision would be very thin. My scar is in fact very thin and about 2 inches long. I did care about the length, but was more concerned about the accuracy of the incision and the skill placing the scar in the proper wrinkle on the neck. It has faded significantly over the last 13 weeks since the operation, and I am, overall, pleased with the cosmetic results. I am told that at this point it is hardly noticeable (I of course, disagree, as I see it constantly, but I digress ....).

Thanks for posting as always!

[Hidden]

After 3 thyroid operations. 1=partial, 2=FAILED total (surgeon was not skilled enough), 3=Successful total, my opinion, for what it counts, is that surgeons will only ever operate if there is no other option and not to do so will endanger your life.

Under those conditions I was prepared to accept as big and as ugly a scar as was possible so long as the surgeon could do his job with no hindrances.

I now have 3 large parallel scars on my neck but I am still alive which is what matters most. I am rather proud of them.

Requesting minimally invasive treatment risks your life for the sake of vanity.

[Greekchick in reply to Hidden]

I couldnt agree with you more and well said. I didn’t particularly worry about the scarring, but since helvella asked, I told him. I was more worried about losing my voice permanently. I had a superb surgeon who left me with my voice and parathyroids intact and a great recovery. Hope you are doing well after such an ordeal.

[helvella in reply to Greekchick]

Nerve damage and parathyroids are, absolutely in my view, the most important. But afterwards, possibly years later, the scar might seem to have a disproportionate effect.

[Greekchick in reply to Hidden]

Also, at least here, you cannot request a particular technique it’s entirely up to the surgeon and what he feels they need to do to get the job done - I just wanted to get a safe and good surgery.

[SilverAvocado]

I was actually rather disappointed by how small the scar is As I'm pretty disabled I find myself quite often mentioning that I've had my thyroid removed... If I can get away with it I say 'part of my endocrine system', to give them less specifics they can make a judgement about.

I find myself gesturing to my throat, but I know no-one will see the scar unless they're v close in good lighting.

It would be nice to have a visible wound to match the internal wound!

[Greekchick in reply to SilverAvocado]

We all have had such different experiences with our surgeries and how we feel about our scars. I have mixed feelings about my scar because it is so new for me still at 13 weeks. Part of me agrees with both you and Panda321 (both of you brave women) and showing it off - and the other part of me - because my work is very public - doesn’t want it to be seen for the reasons you mention.

And while I am a very strong person, every time I see the scar, I realize I no longer have my thyroid and I grieve its loss - and I recognize how strange that may sound to many - even though I had no choice but to remove it because it was crushing my vocal cords and windpipe. I held onto my thyroid for 25 years and managed my Graves as best I could during that time - and it’s hard to believe it’s gone. Funny enough, I never cared about the large goiter being seen because I still had my thyroid!

Some days I leave my scar visible and on others I cover it up. I guess time will tell how I feel. Of course, it goes without saying how grateful and blessed I have been that I had good care after reading some of the terrible experiences people report on this forum. I appreciate being able to learn from the experiences of others here and to get encouragement from the strength of all of you as well.

[SilverAvocado in reply to Greekchick]

Yes, I had the feeling that if you're able to return to work and to the life from before and often 'pass', then a person would want a scar to match, that isn't very visible.

Whereas because I'm still very sick, I'm not so interested in hiding it.

It's a very complex person journey, the relationship to sickness and whether you consider yourself an ill or disabled person, I think. And how much your life changes, both the changes that are forced and the changes you decide to make yourself to manage it. 13 weeks is a very short time to get to grips with it!

[Greekchick in reply to SilverAvocado]

You are so right about coming to terms with things and realizing what a short time it has been - and I am so hard on myself expecting to just get on with it - and I’m not there quite yet. I know I will get there eventually.

I am so sorry to hear you are still ill- and sending you good wishes for your health . Thanks for your thoughts today. I so appreciate them.

[SilverAvocado in reply to Greekchick]

I think it's really really important to be kind to yourself

This is a serious operation and it's a big change for your body! Treat yourself at least as gently as if you'd had a broken leg or something else more visible. Medics and friends and family don't really help with this - usually they want us to be back to normal asap and not disrupt things. It's up to us to carve out that space for ourselves! More difficult to do when we feel vulnerable and low in energy.

[thyr01d]

My Mum's reaction was to say she needed a wide gold necklace to hide the scar. My step-father promptly went out and bought her one, nearly 1 cm wide in pure gold. It seemed to me rather to draw attention to the scar but since Mum thought it hid it and loved the necklace everyone was happy!