Breast Lift + Augmentation 2.5 Weeks Ago, Healing Problems?

The left breast has a brown scab looking spot right below the areola. Dr. said that it was from stretching of the skin. She has had me keep it moist with ointment and covering with no stick gauze. I notice some yellowing on parts (not puss) but the brown spot is still there and doesn't seem to be getting better. Any idea what this is and how long it will take to heal? I am worried I will have skin loss although she assured me it didn't look to be necrosis and it's not an actual split or hole.

Doctor Answers 6

Healing problems with breast lift plus implants.

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Basically your doctor is right and is giving good advice. But, your concern and question indicate that you feel incompletely educated about what is actually going on (or that perhaps your surgeon's answer is a bit cagy or defensive). So I'll try to help you out.

Obviously, the right breast is healing properly without a similar "brown scab looking spot right below the areola." This is how your left breast should look. But, it has an area of incomplete healing (the brown scab looking spot) secondary to partial tissue loss (death). This was caused by inadequate circulation to keep the skin edge alive at that specific spot. Inadequate circulation can be a result of excessive stretch, swelling, bleeding causing pressure, or just insufficient localized perfusion of red blood cells in the skin capillaries near the incision edges. The tissue in this area died, and the scab resulted, covering the living tissue beneath. If the dead tissue becomes infected, adjacent tissue can also die, the tissue loss area increases, and the suture line could break down. Thus the ointment and local wound care.

Since the scab covers living tissue, it is not removed (unless it does become infected), and the living tissue layers beneath heal and a new skin surface (epithelium) grows from the edges of the living tissue to eventually cover the area of (hopefully partial-thickness) skin loss. The bigger the area of scabbing and the deeper the dead tissue, the larger the eventual scar, which is always smaller than the original scab or wound. The final scar is always remarkably less than the patient always worries about. Hence your surgeon's reassuring attitude, if not adequately-informing details.

BTW, necrosis IS dead skin or dead fat, but surgeons don't like to use that word because patients respond inappropriately to it. (Sort of like the word gangrene, which is another medical word describing dead tissue which can be wet or dry.) The real issue is the extent and depth of the ischemic (lack of circulation) tissue loss and how to minimize its degree and hasten healing without incurring further tissue loss from infection, drying out of still-alive but marginal tissues, or trauma and further wound breakdown.

You already have had skin loss, though it sounds minimal, well-treated, and of truly minimal consequence to your final scarring (it may be a few millimeters wider here but will fade like the rest of your scars over time). Be careful, follow your surgeon's directions, and this will be just fine in a few weeks. Do not scrub hard, soak long, or bump or damage this weak and not-yet-healed area. Best wishes!

Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Breast Augmentation with Lift. Questions about healing.

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This happens with this operation as the incisions are on tension.  It sounds like the plastic surgeon has looked at the situation and decided a reasonable course of action.  You are very early into the process.  This may take several weeks to resolve.  Also you already know that the green or yellow that you see in the wound is most likely not pus, but fibrinous exudate.  This is part of healing a wound.  Please keep in close contact with your plastic surgeon.  Together you will get through the healing process.

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

Healing Problems after Breast Augmentation/Lifting?

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Thank you for the question.

Some “scabbing” is quite normal after breast lifting surgery. I would treat the area like your plastic surgeon has suggested. Keeping the scab on as long as possible (avoiding manipulation)  is in your best interests.  This will allow the underlying tissue to heal with the scab serving as a “biological Band-Aid”.

I hope this helps.

Concerns about healing of the breast following a breast augmentation and lift

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It sounds like you have a healing issue that may end up being of little consequence. Without photos, it is impossible to accurately assess and advise you of your circumstance. From what you related regarding comments made by your plastic surgeon, this does not appear to be a major issue. Therefore, I would suggest continuing to follow her recommendations along with close follow up. Ask her questions if you do not understand what exactly is going on.

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
4.7 out of 5 stars 33 reviews

Breast lift and augmentation

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Without seeing photos it is difficult to say what you have on your breast and how best to treat it.  Follow your doctor's instructions.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Augmentation and Lift, now with small wound post-op

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This is a common situation post-op on a lift and augmentation combined, I always tell my patients there will be some type of small wound healing and this usually resolves in 2-4 weeks. Your surgeon seems to be handling the situation wonderfully, continue to follow post op instructions and in time this will heal and you will look great!

Jonathan Weiler, MD
Baton Rouge Plastic Surgeon
4.9 out of 5 stars 93 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.