Recovery From Breast Reduction Is Dependent Upon the Amount of Tissue Necrosis & Patient's Wound Healing Characteristics
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.
Secondary healing in breast reduction
Breakdown of the incision especialy at the "T" is fairly common after breast reduction surgery. When they drain, it may take a few weeks to possibly a few months to completely heal. This had to be followed carefully by your doctor.
Could it also be a suture?
Four months is a long time for what sounds like a small area of non-healing. We tend to use Silvadene cream as our preferred treatment whn there is some tissue necrosis. It keeps the area clean and moist and promotes healing. I wonder whehther a permanent suture could be the cause of non-healing. You can easily find out from your surgeon. Fat necrosis is possible, although the areas of fat necrosis end up being very hard and do heal.
Any pressure on the area from a bra that rides up will tend to keep the wound from healing. Hang in there and keep your doctor posted.
Healing Following Breast Reduction Depends on the Type of Incision Made & the Patient's Healing Process
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.
Wound Healing after Breast Reduction?
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).
Tissue healing after breast reduction
Breast reduction surgery is physically very well tolerated with few incidents of complications in wound healing. However if you should experience a wound breakdown or a scar separation, discuss your concerns with your plastic surgeon. They will typically recommend wound care which will consist of changing dressings and removing dead or dry tissue. The amount of time it takes to heal these wounds depends on the size and depth of the wound. Although this is inconvenient, these wounds to heal well and usually leave an acceptable result although the scar may be wider than initially hoped for.
Tissue necrosis can take a few months to heal
Make sure your surgeon takes a close look at the wound to make sure nothing correctable is there - like a suture. Otherwise it can take weeks to months to close.
Difficult to say without examining you
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.
Tissue necrosis with breast reduction
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.
Fat necrosis may take awhile to heal
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.