There are multiple techniques for improving the appearance of a neck scar after thyroid or parathyroid surgery. In fact, the number of different ways to do thyroid and parathyroid surgery (more than 20!) is a testament to the fact that so many patients would prefer to avoid a scar on their neck. One of the techniques that can sometimes be used is known as TOAST (TransOral And Submental Thyroidectomy).
Like the more widely accepted "scarless" transoral technique (known as TOETVA), TOAST uses incisions inside of the lower lip. The primary difference between the two techniques is that TOAST involves placing a scar on the neck as well. This scar is higher than what is normally used in traditional thyroid surgery, and the hypothesis is that the scar is therefore less visible beneath the chin.
The main advantage is for the surgeon: a scar on the neck makes it easier to remove a big thyroid gland. Some surgeons believe that it makes the surgery faster. Surgeons with less experience may choose this technique more frequently. Worldwide, however, surgeons who do TOAST are few and far between when compared to surgeons who do TOETVA. That is because there have not been demonstrated advantages to the patient when surgeons use the TOAST approach for thyroid surgery.
At the Russell Center, we do use this TOAST technique when it is absolutely necessary (only once every few years). It is straightforward. Primarily, we would use it for an extremely large or firm nodule.
Why don't we use it more often? Because research about neck scars is conclusive: if you have a scar on your neck, your overall satisfaction with the appearance of your neck and skin after surgery will be lower than if you don't have a scar.
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