Areola Necrosis After Breast Augmentation

I had a periareolar breast augmentation with 375 cc implants. My size was a cup A. After the surgery I have had terrible pain for 20 days and tissue necrosis developed along the cut,bilateraly.The wounds closed in two months leaving bad scars. Why did it happen?

Doctor Answers 11

Periareolar Scars

Sounds like you had blistering along the areolar side of the incision due to retraction during surgery. This is partial thickness  but can create unsightly scarring. This can be improved with a simple scar revision under local.

Los Angeles Plastic Surgeon
5.0 out of 5 stars 12 reviews

Areolar necrosis

Many factors contribute to incisional wound healing problems. For a periareolar breast augmentation, these can include smoking, infection, excessive traction on the incision during pocket dissection and implant placement, undermining and devasculariztion of the the skin edges, and excessive tension on the closure. The issue at this point is less about the cause and more about the correction. Scar revision can be performed but it is advised to wait at least 6 months to a year to allow for the scar itself to finish remodeling. Often by waiting, the final scar appearance is much less concerning than it is even a few months after surgery. It is important to discuss these issues with your plastic surgeon.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 13 reviews

Areolar necrosis after breast augmentation

The cause of areolar necrosis is not easily explained and could be due to several factors that relate to your body and the response to an injury versus the techniques utilized. Excessive friction or traction on the wound edges could be responsible, use of electrocautery, tape sensitivity, or topical agent allergic reaction, suture extrusion, wound tension, etc are just some of the potential explanations. Scar revision may be an option to improve the quality of the scars.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 60 reviews

Areola Necrosis

This can happen even to the best of surgeons. It would be difficult to say exactly why it happened to you, and some reasons may be:

Are you a smoker? Tissue necrosis and infection are at a higher risk in smokers.
Infection - this is a higher risk with the periareolar incision, which is why I take extra precautions when performing this incision.
Excessive tension on the incisions.

You should probably talk to your surgeon about this. They may be able to give you some insight. 

Necrosis cause

I'm sorry to hear about your experience. There are many reasons why necrosis occurs, such as inadequate blood flow to the area and infection. Smoking increases the risk of necrosis. Please ask your surgeon to find out what may have caused necrosis in your situation. 

Skin loss along incision edges after augmentation

The most likely cause of skin loss following breast enlargement is to much trauma.  You state that you were an A cup prior to surgery and most likely had very small areola to begin with.  During the dissection too much traction on the retractors could have caused this.  Also, you did not say if you had silicone implants placed.  If so, a 375 cc implant is large and you could have received a friction burn while you implant was inserted.  The   treatment is simple.   Have your surgeon excise the damaged skin or scar and repair it after a 6 to 9 month period.

Gary H. Manchester, MD (retired)
San Diego Plastic Surgeon
5.0 out of 5 stars 1 review

Open wounds after breast augmentation

There is insufficient information to answer your question. If you started with an A cup you should not have needed any lift procedure at the same time as the augmentation. This is probably one of the more common causes of nipple areola necrosis after breast augmentation. The double assault on the nipple areola of lifting and augmenting cuts out needed blood supply. Other causes can be disruption due to the pressure of the implant or infection due to patient or operating procedure factors. To the lay person disruption of the incision line can look like necrosis when it is not. Despite that and whatever the cause you are lucky that it healed over even with a scar. Open wounds over breast implants that do not heal for months have very high risks of implant exposure or extrusion. I would think that after all that your risk of capsular contracture is higher than it otherwise would be.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Poor healing after breast surgery

Delayed healing around the nipple as a result of breast augmentation and periareolar lift can be of several causes. Poor circulation to the skin edge from smoking history, previous surgery,  tension, or the procedure itself is one reason. In addition, any pressure or excessive tightness around the nipple can lead to this. Infections, sutures, bleeding or fluid accumulations can result in tissue tightness and necrosis.

Incision Breakdown Usually Due To Smoking or Too Tight A Closure

Without knowing your history and the surgical technique, it is hard to say why you developed some delayed wound healing at the periareolar incision site.  If you are a smoker, then this would be the main culprit, since smoking really inhibits your ability to heal and makes the chances of some tissue necrosis alot higher.  If you are not a smoker, then it could be that the closure of the incision was just too tight ( areola are too small or the implants were too big).  With the pressure, it can make the incisonsopen a little and heal wider.  Either way, you should give it about 6 months, then reassess the scars and see if they need some sort of revision.  I hope this helps. 

Necrosis after Breast Augmentation

Areola Necrosis After Breast Augmentation
I had a periareolar breast augmentation with 375 cc implants. My size was a cup A. After the surgery I have had terrible pain for 20 days and tissue necrosis developed along the cut,bilateraly.The wounds closed in two months leaving bad scars. Why did it happen?

This is not very common if this was simply a breast augmentation, not a breast augmentation with lift.  I would have to see that it is difficult to speculate what happened, but from general wound healing, wounds that are closed under great amount of tension, or mishandled usually do not do as well.  Also patients who smoke up to the time of surgery have greater wound healing issues as well.

Hope that clears things up a bit.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 60 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.