Wound Separation After Stitches Removed? (photo)

Question

Had my stitches removed after 2 weeks. That evening I had experienced separation. The PS office said to do a wet to dry twice a day. I am following up in the morning with an appt. after starting the wet to dry it appears the wounds are getting bigger. Could they restitch or use steri strips to reclose or reinforce what is closed. Scared that more will open. Had partial nipple necrosis and an infection earlier on. Infection was cleared with antibiotics. Super depressed. Please help.

Richard J. Bruneteau, MD · Answer

It’s not unusual for patients
to have wound healing problems following keyhole mastopexies. The problem typically occurs where the
vertical incision meets the transverse incision. This location is at risk for wound separation
for a variety of reasons. These include
poor blood supply to the skin flaps in this location, the downward force of the
breast tissue against the closure, and high levels of bacteria that occur in
the area of the inframammary fold. All
of these factors can contribute significantly to wound breakdown in this area.Once wound breakdown has occurred, wounds tend to heal by
a process known as secondary intention.These wounds form a layer of granulation tissue and eventually the skin
grows over the top of this layer. As the
wound heals, there’s usually an intense inflammatory response that can make the
wound look red and angry.These wounds should be monitored closely.If infection appears, antibiotics should be
started immediately.In the interim,
local wound care should be continued with dressing changes.When this approach is taken, wounds tend to
heal nicely.Rarely scar revision may be
necessary as a secondary procedure.It’s important that you maintain close contact with your
plastic surgeon.Your plastic surgeon
can answer all of your questions and help you get through this very difficult
experience.

Gary M. Horndeski, MD · Answer

With
the Wise pattern, the T-shaped incision frequently dehisces.  You are an example of what to expect with
this technique.  For this reason, I have
not used the Wise pattern for over twenty years.  The technique I recommend is The Bellesoma
Method, which avoids T incisions.  Your treatment
is wound care, debridement and possible scar revision.Best Wishes,Gary Horndeski, M.D.

Jeffrey J. Roth, MD, FACS · Answer

Thank you for the photo.  What you are experiencing is not uncommon with breast lifts and reductions.  The area is on tension, and that may effect wound healing.  There may also be a spitting suture or some other issue. Suture or steri-strips is not what is needed at this point.  Please continue to be seen by your board certified plastic surgeon, and tell him/her your concerns.  Together, you should be able to come up with a plan.

Jeff Angobaldo, MD · Answer

Thank you for sending your question and photo.  Separation in this area can occur with breast lift and implant surgery. Continue to  cleanse and apply antibacterial ointment.  Wash hands prior to application.  It will heal in 3-8 weeks and it will hardly be noticeable.  If it is, then your surgeon can perform a small scar revision in 6 months. I would not recommend re-suturing the areas.  Please discuss your concerns and follow closely with your Plastic Surgeon.

Kenneth Hughes, MD · Answer

Wound separation is one of the most common issues in a full breast lift, particularly at the T-junction. Usually this area heals very well. The openings continue to contract and the scars lighten over the course of a year.

Asif Pirani, MD, FRCS(C) · Answer

It is quite unfortunate that you are in this situation.  WIthout knowing all of the details of your situation, it is difficult to provide a specific treatment regimen.  Seeing your surgeon, as you are doing, is the best thing right now.  

	 

	In general, I would take a swab of the area and send it for cultures so that I could target the specific microbe causing your infection.  Until those cultures returned, I would start you on an antibiotic and an antimicrobial based dressing.  I find Acticoat to be a great product as it also decreases inflammation.  Having said that, it is not critical - the antibiotics and basic wound care should get the job done.  At this time, you need to be patient and wait for the wounds to heal and the infection to clear.  I know this is easier said than done, but Time really is your best friend right now.

	 

	Please ensure that you are consulting your surgeon regularly during the next few weeks.

	 

	Best,

	Asif Pirani, MD, FRCS(C)

Vishnu Rumalla, MD · Answer

Sorry for your difficult post-operative course, I can see you had a reduction or lift. Factors like smoking, need for significant lifting, large reductions, and simultaneous placement of implants can increase the likelihood of wound complications. You are doing the right thing to closely follow your surgeon's advice. I would not put stitches at this point into the wound and I would wait a whole year letting your scars improve before talking about scar revision. Good luck.

Tom J. Pousti, MD · Answer

I am sorry to hear that you are going through this complication.  The important thing is that you are being followed up by your plastic surgeon who is in the best position to treat the complication.  You should be happy t know that the majority of patients who go through this go on to heal without long term sequeli.

	Sometimes, scar revision surgery may be necessary to improve the outcome in the longterm.  During this process, try to stay as emotionally "even keeled" as possible.

	Best wishes.

Steven Wallach, MD · Answer

Sorry to hear about your situation, but wound separation can occur for several reasons.  Smoking is often a big issue. Local wound care often clears this up.  Follow closely with your surgeon.

Jourdan Gottlieb, MD · Answer

Although it may seem counterintuitive, it is usually a bad idea to reclose an incision in this situation because of an unacceptably high incidence of wound infection, requiring reopening the incisions and starting further behind than you are now. 

	I am not sure how the infection was diagnosed earlier in your course, but at this stage your surgeon should consider antibiotic treatment based upon cultures of the wounds that you currently have. 

	Often, once these are healed, the incisions look no different than if no wound healing issues had occurred. Continue to follow up closely with your surgeon. Best wishes.

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Wound Separation After Stitches Removed? (photo)

Answers (12)

BREAST LIFT PROVIDERS NEAR YOU