How Long Before Tissue Necrosis Heals After Breast Reduction?

Wound breakdown and tissue necrosis occasionally occurs following breast reduction surgery. Several factors contribute to this phenomena. These include the weight of the tissue that supports the blood supply to the nipple/areola complex, thinning of the skin secondary to constant gravitational forces, limited blood supply to the most distant portions of the skin flaps, and chronic bacterial colonization in the area of the folds beneath the breast. In addition to this, external factors such as cigarette smoking and steroid use may also contribute to wound breakdown and soft tissue necrosis.
Most cases of wound breakdown following breast reduction surgery can be managed with local wound care. This includes removal of the necrotic tissue and dressing changes. Some patients may require the use of a VAC, which shortens healing times by applying continuous suction to the wound. In severe cases, removal of the necrotic tissue followed by flap reconstruction or skin grafting may be necessary.
When wounds heal with dressing changes, they form granulation tissue in the base of the wound, which gradually decreases the size of the wound. Once this occurs, new skin forms around the margins of the wound and migrates in an inward direction eventually closing the wound. While this is occurring, the wound is pulling its edges together to ultimately decrease the size of the scar.
Wound healing times are entirely dependent upon the amount of tissue necrosis and wound healing characteristics of the patient. Occasionally, patients may need a scar revision once wound healing is complete, but this is uncommon. Even when wounds break down and patients undergo a prolonged period of would healing, they still report high satisfaction rates following breast reduction surgery.

Tissue necrosis can occur and when it does it is usually at the junction of the inverted T scar.  It is usually treated with dressing changes and debridement. Occasionally creams or liquids containing silver are used to decrease the healing time.

It is hard to know exactly what is happening without an exam, but in general things should have healed up by now. If indeed there is some fat necrosis present, you may need a repeat trip to the OR and possibly excision of this necrotic tissue-- this will probably give you the best chance at a speedy recovery.

I would agree that once the dead tissue is completely removed, your wounds should continue to heal.
In the meantime, keep in close contact with your surgeon and notify her/him of any change in the quality of the drainage or any other associated symptoms.
A pulsatile shower head may be a very effective method of cleansing the wound.
While bactroban is an excellent antibiotic (bacterocidal), it can also slow the grow of healing wounds (cellulocidal) and once you do not need it, you should switch to a less potent antibiotic cream, such as silvadene.
Discuss your concerns with your surgeon
Hang in there.

If you developed fat necrosis after a breast reduction (devitalized tissue) which is still present in your breast, then it may take months for your body to metabolize the tissue and heal the area. If there is a significant area, then you may need another minor operation to debride the tissue or drain the area. This is best evaluated by your surgeon. Good luck.

Tissue necrosis, where a portion of tissue dies due to compromised blood supply, is a rare but serious complication that can occur after any surgical procedure, including breast reduction surgery. The healing process for tissue necrosis can vary widely depending on the severity of the necrosis and individual factors such as overall health and the extent of the surgical intervention.
In less severe cases where only a small area of tissue is affected, the necrosis may heal on its own with appropriate wound care, which may involve cleaning the wound, applying dressings, and possibly using medications to promote healing. Healing time for minor tissue necrosis can range from a few weeks to a few months.
However, in more severe cases where a larger area of tissue is affected, surgical intervention may be necessary to remove the necrotic tissue and promote healing. In these instances, the healing process may be prolonged, and additional treatments such as skin grafts or flap reconstruction may be required to restore the appearance and function of the breast.
It's essential to closely monitor the healing process after breast reduction surgery and report any signs of tissue necrosis, such as changes in skin color, texture, or sensation, to your plastic surgeon immediately. Early detection and intervention can help minimize complications and promote optimal healing outcomes. Your plastic surgeon will provide guidance and support throughout the healing process to ensure the best possible outcome.

Good question. After a reduction some patients will develop delayed wound healing at the inverse T, and that can be at the skin level or deeper, at the fat level. The skin level leaves a superficial wound that heals over a month or two under most circumstances. you just need to keep it clean. The fat layer, when it undergoes fat necrosis, can drain and cause pain. this can sometimes get infected and may require additional therapy. If any concern please discuss with your surgeon for evaluation. In most scenarios it all heals on its own.
-Dr. David Mattos, New York Plastic Surgical Group

Delayed healing either happens at the level of the skin or in the deeper tissues, such as that seen with fat necrosis. The most common cause of delayed healing is the T junction opens up slightly and mostly superficially, and typically closes by itself, delaying overall healing by an additional 1-4 weeks. Rarely does this require surgery or sutures to close it. The more serious type of wound healing issue comes with a sizeable portion of fat necrosis occurs, and this leads to an open draining wound with foul smelling (essentially dead) fat draining out of the wound. Sometimes this does require surgery to prevent or treat infection and remove the dead tissue. If you are having fevers and redness or more swelling, you should definitely consult with your surgeon. 

There are many ways to perform a breast reduction.  One of the most common techniques employs an inverted T incision.  The inverted T includes an incision around the areola (the dark tissue around the nipple); a vertical incision between the areola, and the incision at the crease of the breast, and then a longer incision along the crease of the breast.  Where the vertical incision intersects with the incision in the breast crease, wound breakdown can occur.  These corners are the most fragile parts of the repair and may have decreased blood supply.  This point also supports the greater part of the remaining breast weight.  The decreased blood supply comes from the fact that an incision has been made on both sides of the corner. These factors contribute to potential wound healing problems in this area. Wound breakdown in this area can be small or more extensive. These wounds are usually treated with daily cleansing and dressings.  It is helpful to remove any tissue that is clearly dead.  With this type of treatment, these wounds normally heal on their own.  Unfortunately, it can take several weeks.  In most cases, several weeks go by without much indication of healing.  Once you see a pink rim of new skin forming around the edges then the healing process speeds up significantly.  As new skin grows from the sides, the wound will shrink in size and the ultimate scar will normally be smaller than the wound was in the first place.  After healing is complete, a scar revision may be possible to further diminish the size of the scar.

Thank you for the question.

This type of wound healing does occasionally occur after breast reduction surgery.

How long it will take to heal depends on the size of the world and the status of the underlying tissue. This may be anywhere from a few weeks to an additional month.

The important part of this process is close follow-up with your plastic surgeon, who may able to help with light debridement and/or  removal of foreign body (such as suture).

Best wishes.