Necrotic Nipple (Size of Baseball) Due to Radiation. What Can Done Besides Surgery? No infection. Just dead tissue
Doctor Answers 4
Skin necrosis (dead skin) after radiation and surgery, will need immediate surgery, where all necrotic tissue and severly injured radiated tissue including bone (if infected) need to be removed and immediate chest wall reconstruction with a good vascular flap. The Latismus Dorsi myocutaneous flap fits this description. The implants you still have , will need to be removed if there is any hint of contamination or infection.
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Radiation in reconstruction
In the setting of radiation, an expander/implant reconstruction will have a significantly higher complication rate. In your case, you can still have a successful reconstruction with a tissue flap. Either latissimus, TRAM, or DIEP are good options.
Nipple necrosis after nipple sparing mastectomy and radiation
If indeed your nipple is black and necrotic, then you will need it debrided and removed. If there are no signs of infection, your surgeon may be able to salvage your implant reconstruction but may need to downsize your implant. This may lead to a significant asymmetry. Your PS plan's to remove the implant and come back and fight another day also sounds reasonable.