Why is wound separation common during breast reduction recovery and how can it be prevented?

Question

Based on many experiences I've read on this site, it seems like it is not uncommon for an opening/wound separation to appear somewhere along incisions (especially by the "t" site). What causes this to occur, and when should I be concerned? More importantly, how can it be prevented?

Eric Pugash, MD · Answer

Wound separation following breast reduction surgery is more common than it should be. Firstly, it is important to avoiding operating on active smokers. The toxins in cigarettes damage blood flow in the skin and can contribute to skin loss (necrosis) and wound separation. Secondly, it is important for the surgeon to avoid creating excessive tension on the wound closure. Also, it is important to select the appropriate suture types and sizes to allow stable closure. Finally, in order to avoid creating a T-junction, which is the commonest site of separation, I nearly always do a vertical breast reduction. This technique can be used in the great majority of breast reductions, and avoids the inframammary scar entirely. All the best.

Gary M. Horndeski, MD · Answer

Wound separation does not occur using The Bellesoma Method because there are no T-shaped incisions.  The vertical scar has been eliminated.  The other advantages of this technique are that nipple sensation (in 95%) and the ability to breast feed are maintained.  Your breast tissue is reshaped creating upper pole fullness without implants, elevated higher on the chest wall and more medial to increase your cleavage.  Also, the weight of the breast is transferred to the underlying pectoralis major muscle resulting in pain relief without excessive reduction.  This may be an alternative for you if you are considering breast reduction.Best Wishes,Gary Horndeski, M.D.

Donovan Rosas, MD · Answer

The "T" point is an area common for delayed healing. It is a vascular water shed (i.e. relatively diminished blood supply where 3 flaps meet) under high tension.
Patients will typically exhibit some degree of dehiscence (separation) and epidermolysis (sloughing of the upper layers of skin). With some local wound care, these will typically heal secondarily without further intervention.
With regards to your specific question, preventing wounds is a function pre-, intra- and post op factors. Healthy non-smoking candidates who have reached a healthy stable weight (preferably with a BMI < 30) will have reduced risk of complications. Intra-op careful dissection and management of tension is important. Finally, incisional care and support plays a role as well.The best advice is to closely follow the recommendations of your surgeon and be patient as these wounds may take several weeks to resolved entirely.
As always, discuss your concerns with a board certified plastic surgeon (ABPS)
Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons
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Kenneth Hughes, MD · Answer

Separation at the inverted T zone in breast reduction is a very common occurrence.  The good news here is that even a separation of 1 to 1.5 cm will likely heal and contract very well to produce a nice thin scar.  Just keep it dry and remove the tape. If there is a great deal of wound separation, this may still heal well,  but a revision may be needed in the future. Antibiotics are not needed unless there are signs of infection. Follow up with your PS to discuss your concerns.

Daniel Barrett, MD · Answer

Dear Runner2121,
this type of wound is not uncommon after breast reduction. It is usually caused by poor blood flow and increased tension. It can take few weeks or months for wound to fully heal and in most cases it does not cause any issues in the future. 
Daniel Barrett, MD

Ronald J. Edelson, MD · Answer

You are correct about the high incidence of wound separation at the inverted T scar.   This is because it is a site where there is more tension. Even though it is not unusual the site generally heals up very nicely. It is scary when it occurs, but it always heals on its own.

Mary Ghere, MD · Answer

You are correct that wound healing problems are not uncommon with breast reduction surgery.  With breast reduction surgery the breast are completely rearranged and the blood supply to the breast parenchyma and the overlying skin can be altered.  Additionally swelling after surgery can further compromise blood flow temporarily.  It is these temporary changes in blood flow to certain areas (often the T zone due to the multiple incisions) that set up an environment that leads to wound break down.  The good news is that generally these heal very well and will just require some local wound care for a while.  Widened scars if they are present can be revised to be more cosmetic usually under local anesthesia in the office.

Charles Nduka, MD · Answer

The wound separation, most especially on the T site, is caused by the skin tension as the breast area s stretched by the implants. The stretching force causes the wound site to be pulled apart thus causing reopening. These wounds are easily managed by daily proper wound care and what you should focus on preventing is infection. Keep these wound sites clean and dry as much as possible. These will usually heal by their own.

Tom J. Pousti, MD · Answer

Unfortunately, as you mentioned these types of delayed healing problems are not uncommonly encountered, especially at the "T junctions" (related to blood supply and tension concerns). This area is prone to diminished blood flow and/or separation, related to the breast incisions and tension in the area. These wounds go on to heal through a process of contraction where the tissues heal from the sides towards the center of the wound; this process usually takes several weeks to occur, depending on the size of the wound. Occasionally, removal of unhealthy tissue (debridement) and/or removal of exposed sutures, may expedite the healing process.   
 
 I hope this helps.

Sybile Val, MD - Account Suspended · Answer

If you are a smoker, stop.  Smokers are the worse healers and tend to have complications with surgery.  Healthy people following directions and wearing compression garments usually have a good healing experience.

Why is wound separation common during breast reduction recovery and how can it be prevented?

Answers (11)

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