Preconditioning with 1,570-nm Laser before Reduction Mammoplasty in a Patient with a Predisposition for Keloid Scars: A Case Report.

Introduction: Keloid formation remains a major challenge in high-risk surgical patients, and no standard prophylactic strategy has been established. This case reports the use of preoperative 1,570-nm fractional non-ablative laser preconditioning as part of a multimodal scar prevention protocol in a patient with a documented predisposition to keloid scarring. Case Presentation: A 24-year-old woman with symptomatic macromastia and marked tendency for pathological scarring underwent bilateral reduction mammoplasty after several surgeons had previously declined surgery because of her high risk of keloid formation. She received three preoperative 1,570-nm fractional laser sessions over 6 weeks, followed by reduction mammoplasty with meticulous low-tension, multilayered closure. Beginning 14 days postoperatively, she underwent five adjunctive treatment sessions at 6-week intervals using combined fractional 10,600-nm and 1,570-nm laser therapy, with selective intralesional triamcinolone acetonide and ultrasound-assisted delivery. Follow-up through 12 months 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 Vancouver Scar Scale score improved from 9 at 3 months to 1 at 12 months, representing an 88.9% reduction. The patient reported high satisfaction with both functional and aesthetic outcomes. Conclusion: This case suggests that preoperative 1,570-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.