Anchor Breast Lift Incision Separation. What To Expect After Debridement? (photo)

Question

I had a small opening at the "T". I am NOT a smoker. Today I saw my PS and he thought that it was a suture not allowing it to heal. He debrided it. It is now a hole. I trust my doctor but it all happened so fast I forgot to ask some questions. Since he debrided does that mean I have some necrosis? Will it heel quickly now? Is this uncommon? I have a silver patch on it now. He wants to see me weekly now. I'm scared. Will it get bigger? I have no infection. Is the silver patch proper protocol?

Gerald Minniti, MD, FACS · Answer

Hello CantWait77,

	This is fairly common, and your surgeon might have touched upon this indirectly when talking about the possibility of unexpected scarring. This problem is due to the highest tension and the poorest blood supply to the skin flaps in the inverted T region. It sounds like your doctor is doing everything right: not ignoring it, debriding the necrotic tissue (which was apparently minimal from your photos), covering it, and following you closely.  This should heal in one to two weeks, and look angry for a few months before it starts to mature and whiten. Don't be scared, you'll be fine; you might not even desire any revision of this scar.

	Best of luck!

Gary M. Horndeski, MD · Answer

One of the reasons I
never use anchor incisions is because the flaps meet in a T-shape, which frequently
dehisce resulting in open wounds and scarring. 
Your results are typical of this procedure.  It is treated with wound care and you may
eventually need a scar revision.  Best Wishes,Gary Horndeski, M.D.

Sheila S. Nazarian, MD · Answer

That silver stuff is ideal and it will heal this wound quickly.  You are in good hands and this can happen to anyone.  your surgeon is doing all the right things.

Young R. Cho, MD, PhD · Answer

Thank you for your question and for sharing your experience with us.  You will find that every few days the wound will get smaller.  Once the wound closes, it will go through a great deal of remodelling and in many cases become very acceptable in appearance.  If there is a remaining indentation or widening of the scar that is unacceptable, then I would recommend waiting six months to year before undergoing any minor revision. It is important that you stay in touch with your surgeon throughout this process.

Richard J. Bruneteau, MD · Answer

It’s not unusual for patients
to have wound healing problems following keyhole mastopexies.The problem typically occurs where the
vertical incision meets the transverse incision.This location is at risk for wound separation
for a variety of reasons.These include
poor blood supply to the skin flaps in this location, the downward force of the
breast tissue against the closure, and high levels of bacteria that occur in
the area of the inframammary fold.All
of these factors can contribute significantly to wound breakdown in this area.Once breakdown has occurred, wounds tend to heal by secondary
intention.Tissue tends to form a layer
of granulation and wounds contract.The
skin grows over the top of the granulation tissue.In the initial phases of healing, there may
be an intense inflammatory response that can make the wound look red and angry.For these reasons, these wounds should be monitored
closely.If infection appears,
antibiotics should be started immediately.In the interim, local wound care should be continued with dressing
changes.When this approach is taken,
wounds tend to heal nicely.Rarely scar
revision may be necessary as a secondary procedure.If you have questions or concerns about how
your wound is healing, it’s important that you discuss them with your plastic
surgeon.Your surgeon should be able to
address your concerns and alleviate your anxiety.

Jeffrey J. Roth, MD, FACS · Answer

Thank you for the photo.  What you are experiencing is not uncommon with breast lifts and reductions.  The area is on tension, and that may effect wound healing.  There may also be a spitting suture or some other issue. Suture or steri-strips is not what is needed at this point.  Please continue to be seen by your board certified plastic surgeon, and tell him/her your concerns.  Together, you will be able to come up with a plan.

Jeff Angobaldo, MD · Answer

Thank you for sending your question and photo. . Separation in this area can occur with breast lift and implant surgery. Continue to  cleanse and apply silver dressing. Wash hands prior to application. Most likely, your wound will not get bigger.  It will heal in 3-6 weeks and it will hardly be noticeable.  If it is, then your surgeon can perform a small scar revision in 6 months.  Please discuss your concerns with your Plastic Surgeon.

David J. Levens, MD · Answer

You appear to have a common complication of breast lift or reduction, specifically delayed healing, most common at the " inferior T zone".  Smoking is definitely a risk factor, so it is good that you do not smoke, but non-smokers of course can have healing issues.  
Your plastic surgeon is doing just tbe right thing with debridement (removal of dead "necrotic" tissue)' appropriate cleaning and dressings, and close follow up.  
With time you will heal fully and ultimately your scars can be revised as needed.
This minor setback should not affect your overall result in the long run!

Thomas J. Lee, MD · Answer

Thank you for your question.  The skin at the T of the anchor scar has the highest risk of problems following a breast lift or reduction.  That point bears a lot of the strain caused by the weight of the breast, and the skin there is the farthest away from the source of the blood supply from the big arteries that go to the breast.  Both of these things can create a small area where blood flow isn't good enough to allow the incision to heal or even cause small areas of skin to die (necrosis).  Smoking causes constriction of small blood vessels, so this risk is even higher in smokers.  This can be very distressing when it occurs, but the long term result is usually still very good.  Debridement is the first step to get rid of unhealthy tissue to minimize the risk of infection.  You will need to keep the wound clean and moist with daily dressing changes until everything heals.  The surrounding skin will heal into the defect, but it will take some time.  It is good to be seen regularly during the healing process to make sure things are progressing in the right direction, and if there is a problem it can be addressed promptly.

Jeffrey Zwiren, MD · Answer

The wound looks clean and granulating. If it is just not healing an excision can be attempted but there is always a risk that it could develop an abscess. There are only three things that make wound not heal, cancer, infection or a foreign body. Otherwise it should heal on its own. Sometimes it just takes some time.

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