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Is my Nipple Okay? (photo)

Breast lift and aug 7 days ago. I am concerned about the outer edge of my nipple. I realize much of the purple is bruising but some is taking on a black color and is hard/ Crusty to the touch. It is not adhering to the surrounding skin and can be moved. Will this slough off? Will it spread? Dr didn't seem concerned. Could this be partial necrosis?

Doctor Answers (15)

Partial skin loss on nipple after breast lift/aug.

+2

As my colleagues have stated, this does appear to be a case of compromised circulation causing relatively small areas of what will probably end up as partial thickness skin loss. Your surgeon may have seemed to you to be unconcerned, but his response is more likely "There's nothing else to do now but keep the wound edges clean, protected, and let the majority of living tissue go on to heal." Far from being "unconcerned," I suspect he's trying to reassure you that this will go on to heal much better than you are imagining right now as you look at the dark areas!

If ischemia is recognized early on, I recommend 3-times daily application of topical nitropaste to vasodilate marginally-flowing capillaries. Rarely, a Medrol dosepak (oral steroid to reduce inflammation and swelling) may be prescribed. But at one week post-op, what's alive is alive, and what's not cannot be revived. The goal now is to avoid any further tissue loss!

Unless there is wound breakdown or infection, the bruising will resolve, the living tissues will heal, and any dead tissues will form a dry eschar (scab) that will separate and "fall off" as the adjacent living tissues fill in and heal over any areas of tissue or skin loss. Since scars contract, the final result will likely be surprisingly better than you expect, and scars are always capable of being revised under local anesthesia.

If you smoke or are exposed to second-hand smoke, this could be part of the reason for this issue, though ischemic healing concerns can and do (rarely) occur in non-smokers. Please make sure you are not exposed to any kind of nicotine product or second-hand smoke, keep the tissues clean and protected with a clean gauze dressing and a light application of Bacitracin, and continue to follow-up with your surgeon. Sometimes slightly larger areas of skin loss can be excised and re-closed for faster healing, avoidance of an open wound, and less scarring, but most times what your photographs show will go on to heal uneventfully with only minimally-increased scarring. Honest!

Best wishes! Dr. Tholen

Web reference: http://www.mpsmn.com/photogallery/breast-lift-plus-augmentation-5861

Minneapolis Plastic Surgeon
5.0 out of 5 stars 90 reviews

Superficial Nipple Areola Compromise after Breast Aug and Lift

+1

   The picture appears to exhibit a modest amount of nipple areola compromise that appears to be partial thickness.  Most of the time these should go on to heal without a great deal of problems or a compromised scar.  Kenneth Hughes, MD breast augmentation Los Angeles, CA

Los Angeles Plastic Surgeon
5.0 out of 5 stars 147 reviews

Nipple Trauma

+1

It seems that the blood supply to the area has been compromised. I agree with all the suggestions that have been put forth. You basically have to keep the area clean and let good tissue live and bad tissue die off. The key is to keep very close contact with your surgeon so that you can be monitored closely.

Scottsdale Plastic Surgeon
5.0 out of 5 stars 14 reviews

Nipple

+1

You appear to have some bruising and significant swelling. You need to give the swelling time to resolve. 

New York Plastic Surgeon
5.0 out of 5 stars 9 reviews

Nipple Healing after Breast lift and Augmentation

+1

The edges of your nipple appear to have areas which will heal more slowly due to the blood supply not being ideal. The best thing to do now is use antibiotic ointment and ask your surgeon about creams to heal faster such as "wound-be-gone." It will take some time to heal, but will likely end up healing better than it looks.

Web reference: http://www.lakeshoreplasticsurgery.com

Chicago Plastic Surgeon
4.5 out of 5 stars 18 reviews

Is my Nipple Okay?

+1

Appears as a slight skin edge necrosis. This is managed by local wound care and allowing further healing time. 

Miami Plastic Surgeon
4.5 out of 5 stars 55 reviews

Bruising vs superficial necrosis

+1

Hello,

Thank you for the question and photos.  It appears from the photo that it might be either bruising or superficial necrosis ( not enough blood supply).  Regardless of which of the issues is actually the case there is not much that can be done at this time other than to protect the area and keep it clean.  I would try and see your plastic surgeon relatively frequently since he/she will have to guide you along the process.

Web reference: Http://aaaplasticsurgery.com

Scottsdale Plastic Surgeon
5.0 out of 5 stars 72 reviews

Areola Necosis

+1

 I am going to assume you had a periareolar incision with you breast augmentation.  The pictures you have presented appear to represent necrosis at the periphery of the areola. Conservative management is warranted. This means close observation but cold also involve removal of the suspect areas and allow for spontaneous healing with time.

 

Dr. ES

Atlanta Plastic Surgeon
5.0 out of 5 stars 6 reviews

Partial Nipple Necrosis

+1

Dear Sarah,

Although blurry, the photos you have sharing with us show partial necrosis (tissue death) around your areola.

I believe that at this point your surgeon did provide you with a care regimen so maximal healing is achieved; please do follow it.

In the near future, you should anticipate a scar that could be improved after you have achieved total recovery through scar excision.

That being said, please remember that commendable results require an exceptionally skilled surgeon to perform the surgery and settling for anything less than that increases the chances of additional corrective surgeries dramatically.
I hope this helps and please feel free to check the website below.

Thank you for your inquiry and the best of luck to you.



Dr. Sajjadian

 

Web reference: http://www.DrSajjadian.com

Orange County Plastic Surgeon
5.0 out of 5 stars 90 reviews

Partial necrosis of areola after breast lift/augmentation

+1

The outer edge of your areola is showing necrosis. It's hard to discern whether this is partial or total. I assume that your plastic surgeon has seen this and initiated local wound care regimen. At this point, just wait it out and allow time to show just how much or how little the tissue is nonviable. The treatment is then allowing the wound to heal first and then deal with revision later. 

Best Wishes,

Stewart Wang, MD FACS, Wang Plastic Surgery

Los Angeles Plastic Surgeon
4.5 out of 5 stars 19 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.

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