Breast Reduction - Signs of Nipple Necrosis?

I just had a Breast reduction 5 days ago. I went for 3 day check up and dr said everything looked normal but Im still scared bc I didnt see them until that night when I took shower. I have bright red and purple around nipple area(I think blood pooled under surface. My R nipple does not have much bruising or blood under the surface and has feeling. My L nipple has purple bruising underneath it and has no feeling. Is this normal? Both are warm to the touch. What are signs of nipple necrosis?

Doctor Answers 5

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It is not unusual for there to be bruising and for one to be worse or more severe than the other following breast reduction. Similarly, decreased nipple sensation is also common in the early post-operative period. Nipple necrosis may be difficult to assess and a crude way of assessing viablity may be a simple needle prick to see if the area bleeds bright red blood. Discuss your concerns with your surgeon

Chicago Plastic Surgeon
4.9 out of 5 stars 82 reviews

Breast Reduction - Signs of Nipple Necrosis?

It is difficult to evaluate your nipples without seeing you. It sounds as if you have some bruising with one side being worse than the other side.  This occurs after breast reduction and usually is self-limiting.

Paul Vitenas, Jr., MD
Houston Plastic Surgeon
4.8 out of 5 stars 110 reviews

Nipple necrosis?

Without seeing you in person and evaluating your nipple areola complexes it would be difficult to say how yours are doing.  Bruising can happen and numbness can occur.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Could it be Nipple Necrosis?

Nipple Necrosis is very rare and is usually caused by impaired blood flow to the nipple after surgery. The nipple will begin as a purple color and then turn black. Alternatively, your left nipple could just be experiencing more bruising and swelling than the other. I would recommend continued follow-up with your surgeon, but your symptoms are fairly common. Lack of feeling can occur in one, both, or not at all. Have your surgeon monitor and advise.

Robert N. Young, MD, FACS
San Antonio Plastic Surgeon
4.6 out of 5 stars 70 reviews

Nipple viability in Breast Reduction

It is normal for the nipples to be numb and bruised after a breast reduction surgery
After a breast reduction surgery it is pretty rare (but not impossible) to get nipple necrosis.  Most often there is bruising and swelling that will go away with time.  The numbness feeling is also normal and should go away after some time.
Nipple necrosis occurs when the blood supply to the nipple is poor or if the blood outflow is poor.  Poor blood flow into the nipple/areola can happen for various reason, none of which are visible from the outside.  What is visible is that the areola is very very pale and cool.  Over several days it will turn into a scab.  When the outflow of the blood from the nipple/areola occurs, it is usually because there is too much pressure on the tissues.  You would see blue/purple looking nipple/areola (not just a bruise) where the capillary refill is instant.  The entire breast, especially around the nipple/areola feels very very tight.  Over time the area will become a scab and heal like a scar.  
To get nipple/areola necrosis is a rare event.  With the latest vertical technique used at our clinic, the blood flow to the nipple/areola is very well preserved.  However if necrosis should occur, it can be treated with creation of a new nipple/areola.  It is a minor procedure that does not require general anesthesia, only a little bit of local freezing.
Martin Jugenburg, MD

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 474 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.