What is the Underlying Cause of Areola Necrosis ? - Birmingham, UK

Hi. I have attached some rather graphic shots of...

Hi. I have attached some rather graphic shots of my breast so to hopefully help other people close to my situation, they aren't for the faint hearted so I do apologise. Bottom line is I would like to know what is the cause behind my experience of areola necrosis (superficial kind). its been a painful, infection upon infection and copious amounts of antibiotics, loss of work, emotional and so on.... feel as though my life has been turned upside down! My op took place at the end of jan 2013, I had an uplift and implants all at the same time. I was a 38F with my right breast measuring 3.5 cm larger than the left. It's been something I have been debating doing ever since I was 17! turned 30 and thought I have to sort this out for me... Fed up of feeling self conscious - i simply wanted to be able to take my bra off and see a normal looking pair of boobs! Looking back now if I had of known something to this degree could happen I can honestly say I would never have gone through with it ! I have never known pain like this, the first 3 weeks were excruciating - I was so lucky to have had my man take such great care of me, how anyone in my situation could cope alone is beyond me! I believe the necrosis was missed on my first week check up with the nurse, it was picked up the 2nd week by a diff nurse ..... immediately I saw the surgeon who to cut a long story short basically has been amazing in the sense all after care is taken care of and he acted quickly to save as much as he could. The sad fact is I am left with one breast which due to the necrosis has a large open wound and no nipple or areola! He wants to wait - let it breast heal naturally and at a later date do some reconstruction ... So to hopefully resemble a breast ! The underneath scaring a brilliant but the incision to he right breast ( the good one) I don't feel is very good. I wanted to know what the underlying cause of this type of necrosis is? I don't smoke, they had tested a tissue sample prior to going ahead with the op to write off infection and that was all clear .... I can't help but feel after researching this that it all boils down to the incision around the areola being too deep through the epidermis layer causing damage to the blood flow ? or the pressure of the implants / or the band which had I be worn tightly across the chest to help push the implants into place ?? Appreciate your response
Many Thanks
L

Most recent photo of left breast

Appreciate my early photos are pretty horrible, this photo shows where I am after 7 months post op .... almost there but no idea what my end result will be - will keep you posted.
L

what happens now ? :(

Almost 10months since my op... As you can see its not been an easy recovery process. What I hoped and dreamed for since I was 18 yrs was to feel confident and have a beautiful pair of boobs. 30 yrs old and wish I hadn't gone thro with it. But I'm here now and I would like the best advise you can give me in how u believe this should be dealt with and what next steps you think need to happen. my PS has said he will see it through to the end and do all corrective work necessary to achieve good results. I'm somewhat dubious this will be possible. As u can see even after surgery I still have one breast much larger than the other, the right boob has bad scaring from where the necrosis was and perhaps from the breast being heavy ?? The areola I asked for hasn't been achieved (would have liked smaller and more defined areolas) and directly below the right nipple where I had an open wound for a few months, where it's healed it's left my nipple to not react in the way it did before - dull achy feeling, uncomfortable touch. The left breast is a total write off, but they say they will implement a fake areola/ nipple. I know i will never regain full sensitives and feeling I once had - that's the sadist part of this whole affair but is there light through the end of the tunnel, do these nasty looking boobs have a cat in hells chance of looking good good someday ? Thank u for you comments

implant position

Also do you agree the implants don't seem to be sitting in the right place ? Positioned submuscular . they seem to sit more to the side ... From the front u would t know I've had implants. he did not achieve the perky / pointy look I had asked for.

Implant position

Also do you agree the implants don't seem to be sitting in the right place ? Positioned submuscular . they seem to sit more to the side ... From the front u would t know I've had implants. he did not achieve the perky / pointy look I had asked for.
Hospital group

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4 out of 5 stars Answered my questions
4 out of 5 stars After care follow-up
4 out of 5 stars Time spent with me
4 out of 5 stars Phone or email responsiveness
4 out of 5 stars Staff professionalism & courtesy
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Hi there, I went through a similar situation with my tummy tuck. In my cause, since I do not smoke, my necrosis was caused because I was over weight at the time of my surgery. The more layers of fat the harder the blood has to work to flow to your incisions. Did you ever smoke? I am so sorry you had to go through this, its hard to handle for sure.
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You poor thing! What a nightmare! What size and profile did you get? I need to know before I can answer your questions about them sitting to the side. you have very nice cleavage so I do not think you have a pigeon chest like me. Also it may not hurt to post these questions with pics to the real self PS's.
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im so sorry you have had to go through all of this :( i am 3weeks post op from uplift and unders. this was my worst fear! which surgeon did u have at thg? thats who i went with. i have seen pics on here where the breast have been reconstructed after this has happened so you may still have a good result in the end! as for why you developed nipple necrosis, well theie are many factors to take in to consideration How much tissue was taken away? more tissue more risk smoke? even near passive smokers can cause risk alcohol? 4weeks pre and post op diet? haemaglogin level? sometimes there seem to be minimal risks but necrosis can still happen hope things get better for you xx
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BoobsL The same outcome happened to me back in December. I think everyone needs to be aware of this possibility even though very rare (less than 1% occurrence). So rare, it's not even mentioned as a possible risk here in the US. I was shocked to say the least. After thoroughly researching this and talking with several friends who are nurses, the causes are one of three: Smoker, extremely overweight and sagging breasts (for instance, after dramatic weight loss) or the doctor's skill. Since the first two did not apply to me or to you from photographs. I have to go with doctor's skill (although excellent reputation). I was on the operating way too long. Hang in there...it may take some time to totally heal and go through reconstruction, but in the end of it all, I'm sure you will be happy with the new uplifted breasts. You are very young and have many years ahead to enjoy your new appearance. If you didn't have it done, eventually you would have back and shoulder pain.
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I am all better, per se. My incision reopening, which was the center of my tummy tuck, has completely closed and in fact I just confirmed with my ps that I would like a scar revision because that sight is in need of it. Hopefully that will occur next month. I don't think at all that you should just give up trying to find out why this happened. Lack of blood flow to the area caused the necrosis, but what caused the lack of blood flow? Too deep into your epidermis is a likely theory for you, not sure about me. I've accepted that it may never be absolutely clear why mine occurred but I will always have an eye out for explanations. You do have a very positive attitude for what you have dealt with though. I am impressed with your spirit and I do hope for the best for you. Take care!
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I am also sorry to hear about your areola not healing. I can't imagine how difficult this has been both physically and emotionally. How have you been able to function on a daily basis? It looks like you're starting to heal, but it must feel like an eternity of waiting for you. Hang in there and I'll keep my fingers crossed that you heal quickly now. Keep us posted and thank you for sharing your story on RealSelf!

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I'm so sorry to read this, you must have been in terrible pain and such emotional distress. I wish there was a magic wand we could wave and everything would be just as you wanted it. Your breasts are a nice shape, so I hope once the infection and pain is gone you can get a reconstruction and have good results. As the old saying goes, this too shall pass. I have no idea why it happened, I've read that moving the nipple complex too far can cause this but I don't know how far is too far. You could get a second opinion from another PS who might have a theory, but, as much as I understand why you want answers, (I would too!) you may have to prepare yourself for the fact that its just one of those things. Or another PS may be reluctant to comment. Have you tried the doctors on here? Best of luck, sending hugs from about 30 miles away :)
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Hello Allie, from 30 miles away :) thsnk u for ur comments. have you had surgery urself ? How was ur experience ? everything u say makes sense ... I know I should drop it and at the end if the day does it really matter what happened and why - because it's done... Just got to get better and hope in time ill have a nice pair of boobies. Yet still want answers. Part of me is angry - mainly at myself for having gone thro with the op ( wish I loved myself for what I had, saggy n all lol) and I look at other women who have lost their breast thro cancer and think get over urself -I'm lucky compared to them. It's just that I did everything I could to make sure I was healthy, high protein diet, zinc, vit c, iron etc. non smoker. Saw a doc on tv the other night a d surgeon said the cause of necrosis is caused by the an incision going to deep through to the epidermis layer - causing lack of blood flow meaning the areola / nipple will go black and die. Guess I just wanted to hear someone say it. Something must cause it to happen. still ur wise words ring true and u talk a lot of sense. So thank u. Hope all is well with u. Take care and ill keep you ladies posted x
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No, I'm awaiting a gastric sleeve, so I wouldn't be surprised if I need a breast lift at some time. I just find the stories interesting, and sometimes sad. Any of us could say 'oh well there's loads worse off than me' but its you inside your body and you have every right to be upset - it must be hard to wish you'd never even done it in the first place :( I'm sure you will end up with a good result and no one can ever take them away. I'm about 30 miles from Brum btw, I didn't read your post properly. That Hospital Group seem to advertise everywhere, I'm having the sleeve done NHS because I'm in a wheelchair and my disease caused the weight gain, but I'll think hard about any more surgery. I wonder if the first nurse had caught your problem it could have been better. :(
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WOW, what you are dealing with is so sad. The improvement to your right breast is excellent though, especially relative to your left. I really hope everything turns out ok for you. I have dealt with post-op complications (though not to that degree, but I did have to pack an incision that reopened for 5 months) so I understand a bit about the frustration of trying to understand why and the patience required. I am glad you are receiving such good care now and wish you all the best. Please update your progress as your situation evolves. Thank you for sharing.
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Thank you so much for your response - means alot. Only sorry to hear you ha e suffered also. It's hard isn't it. Still I try to stay as positive as possible. Count myself lucky in many ways that at least I still have my breast. They may be different and yes ots been traumatic but it could have been worse. I do want answers - think it'll help me accept why it's happened. Saw a doc on the bbc the other night and the surgeon basically confirmed that the cause of necrosis is when the incision goes too deep into the epidermis layer causing lack blood flow to the area .... Makes sense, seeing I don't smoke and have a high diet of protein, since, iron and vit c! just wanted to see whether the docs on here agree! Are you all better now ? x
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