Best Treatment for Necrotic Areolas, Nipples and Attached Scar?

6 wks ago full breast reduct. w/ liposuc of 500cc+ each side and had hematoma on right breast 9 hrs later fixed w/ suction of area, drain cleaned; hemat. killed right areola now is necrotic. Dressings removed, likely affected left areola/nipple, also went necrotic. What is best tx for necrotic scar, keep dry or moist (daily saline + jelonet), how long to heal? Feel both nipples. Rev surg/tattoo eventually I guess. Also massage of attached scar not helping, best tx? Mid 50s. Monitor weekly? Thanx

Doctor Answers (6)

Breast Reduction Complications including Loss of Nipple and Areola

+3

Hi W8297 in CA,

I'm obviously very sorry for the problem you're having.  Tissue loss, including the nipple and/or areola, are recognized potential complications that are, fortunately, very rare, but when they occur to you they don't seem so rare.

I would generally advise conservative management at this stage, with moist dressings and/or antibiotic ointment until the eschar (thickened, black tissue) has separated.  I would then maintain a non-adherent dressing until the tissue has healed.  As you indicated, further revision, possibly including tattooing, may be indicated, and this is a good time to stay in touch with your plastic surgeon.  Nobody's happy with this situation and I think you'll get the best ultimate result most easily if you can maintain your relationship with your own plastic surgeon.  Often the end result is not quite as bad as you fear it will be but, either way, a certain amount of work will be involved to get the best result possible.

I hope that this helps, and good luck,

Dr. E


New York Plastic Surgeon
5.0 out of 5 stars 155 reviews

Necrotic nipple

+2

I am sorry that you are having these difficulties, but this is the time when you follow closely with your surgeon and follow his/her instructions.

 

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Nipple loss after breast reduction

+2

Fortunately nipple loss after breast reduction is uncommon, though for all surgeons in practice long enough, we know that the risk is a real one. I cannot recognize the scar pattern, vertical or 'T' from your photo, though we often debride conservatively when nipple loss occurs. We like a saline moist dressing until the degree of loss 'declares' itself and then clean the area and continue moist dressings until the wounds close. Often there is more recovery than what might be expected, and skin grafting and tattooing do indeed provide solutions to the problem. You will be in this for a long while with your surgeon.

Best of luck,

peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 30 reviews

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Nipple necrosis following breast reduction

+1
I am sorry that you have had this difficult problem.  See your surgeon frequently so that they may do the best they can to help you through this process.  Most likely you should let it heal for a few months, then reassess for revision surgery and tattoos.

David Stoker, MD
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Best Treatment for Necrotic Areolas, Nipples and Attached Scar

+1

This is an unfortunate occurrence that you are going through.  Please listen to your surgeon as you go through the delayed healing process.  Wet to dry saline dressing may be sued or antibiotic topical such as Silvadene is frequently used.  After a period of time your surgeon will be able to see more clearly what is left and what is missing and determine which route to take on reconstruction of the nipple areolar complex.

Paul Vitenas, Jr., MD
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Nipple loss after breast reduction

+1

That is a really unfortunate outcome, and I'm sorry you're going through that! Partial or complete nipple loss is a recognized potential risk of breast reduction, but thankfully uncommon. It is not clear to me what technique of reduction was used based on the photos. It looks like you have incisions extending on either side of the nipple areola complex. At this point, based on the appearance in the photos, I would recommend antibiotic ointment to the black and yellow dry areas until they soften and peel off (or are conservatively debrided by your surgeon). The end result may look better than expected. If nipple areola reconstruction is needed, and/or tattooing for pigment, this can be done once you have healed. Good luck!

Anita Patel, MD
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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.