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

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?

Doctor Answers 14

Wound separation in anchor incision

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Repeat after me:  "This too shall pass.  This too shall heal." 

This problem of spitting stiches and wound separtion can happen after just about any procedure where structures are lifted and/or tightened.   It is always very frightening for patients a it is for you.  Patients are almost always amazed that it does heal with time and often ends up looking JUST FINE.

If you end up "spitting" a lot of your sutures, make sure the surgeon writes they type of suture down for you.  Some patients are very sensitive to certain type of suture.  In my practice, Vicryl sutures cause the most problems.

Keep you appoinments with your surgeon, follow his/her instructions and have faith in Mother Nature and the mystical power of the body to heal. 

Seattle Plastic Surgeon
5.0 out of 5 stars 77 reviews

Anchor Scar Wounds

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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!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Anchor ("Inverted T") Breast Lift Wound Separation

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Unfortunately you are suffering a known complication of the procedure. I assume its possibility was discussed with you before the surgery and it certainly should have been discussed with you at your last visit. It is ALWAYS a good idea to go to your surgeon's visits with another person who can listen to the same information conveyed to you and ask questions you cannot think of asking because you may be overwhelmed.

Whenever Plastic surgeons lift skin off the underlying structures and close it with a vertical T pattern the blood vessels and circulations in this area are adversely affected. If further compromise is added by either swelling, tension, compression or underlying medical conditions such as Diabetes, Autoimmune diseases or ingesting/inhaling Nicotine can all bring about a critical loss of blood flow in that skin causing the death of that skin.

This APPEARS to be the case with you. The next step is to remove the dead tissue (surgical debridement) to limit the ability of germs to thrive in that area and encourage the inherent ability of the skin to heal itself (healing by secondary intention). Frequent small debridements of tissue which is not pink or red are required and can be done surgically, enzymatically by frequent dressing changes and by combination of these treatments. Using silver , as is done in your case, or in a cream (Silvadene) penetrates compromised, bloodless tissue killing bacteria and prevents infection.

As dark and scary as things look now, this is NOT permanent. You will heal. Do whatever your surgeon tells you to do and make sure you ask him/her any questions you have. I'm SURE he/she would be more than glad to educate you.

Remember, this is a temporary setback. It's NOT the ultimate result.

Peter A. Aldea, MD
Memphis, TN

Peter A. Aldea, MD
Memphis Plastic Surgeon

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Monitor Closely-Change Dressings-Watch For Infection

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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.

Anchor Breast Lift Incision Separation. What To Expect After Debridement

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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.

May need more time to heal

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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.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Open anchor incision

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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.

Anchor lift incision separation. Now post debridment.

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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.                

Jeffrey J. Roth, MD, FACS
Las Vegas Plastic Surgeon
4.6 out of 5 stars 17 reviews

Don't despair

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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!

David J. Levens, MD
Coral Springs Plastic Surgeon
5.0 out of 5 stars 79 reviews

Common issue after inveretd T surgery

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This is unfortunately not a rare issue after an inverted T incision.  Good news is you doctor is taking the right approach and taking care of you.  This will heal in a few weeks time with appropriate wound care.

Kevin Tehrani, MD, FACS
New York Plastic Surgeon
4.7 out of 5 stars 112 reviews

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.