Like all body skin, breast skin has a blood supply which can be compromised by any incision or surgery. Healing problems can range from insignificant to wide areas of skin necrosis or loss. This is common enough that complex technologies are often utilized in the OR especially during cancer mastectomies to evaluate breast skin circulation. Even then, not an exact science. The breast reduction skin zone shown in these photos is called the "trifurcation area". It is the point of maximum tension of the closure and it also sadly is the point of the least blood circulation. Healing problems in this zone are not uncommon but can often heal in without additional surgery as appears to be the case here. With the wound now safely closed, attention to the scar appearance can become the priority. Sun protection, silicone scar gel, and patience during the full year of healing are cornerstones. Other modalities such as hydroquinones and lasers may have a role in select patients. Surgical scar revisions may also be considered where and when indicated. Steven L Garner, MD, FACSSanta Cruz, CA
