Breast Reduction - Signs of Nipple Necrosis?

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

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.

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.

Sincerely,

Martin Jugenburg, MD

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.

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.