Is This Normal? What Do I Do if my Plastic Surgeon Won't Help Me? (photo)

I am 38 years old and undergone a breast augmentation (due to back problems) on January 15, 2012. The next day my left breast had split open about the size of a dime. I called the surgeons office and was told by the dr. & his nurse that it is normal but probably caused due to me smoking 1-2 cigs a day. The pain is terrible, what should I do ?

Doctor Answers 12

Smoking and surgery

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Your surgeon should definitely help you with this issue regardless of the cause.  There is dead tissue  due to low blood flow to these areas.  The treatment is dressing changes until all the dead tissue is removed and either allowed to close by itself or another surgery to suture the tissue.
Here are the major points of smoking Tobacco or Marijuana before or after surgery:
1. There is nicotine in tobacco, but not in marijuana. However, most joints are rolled with marijuana and tobacco combination. Nicotine is a vasoconstrictor that decreases blood flow to the tissues. This is the major problems that can cause a very bad outcome in some surgeries. In a breast augmentation, there is not a lot of risk as there are not a lot of incisions which decrease blood flow to the tissues. In a breast lift or tummy tuck, on the other hand, there is much longer and more involved incisions. The decrease in blood flow to the tissues in combination with the decrease in blood flow from the nicotine can cause tissue to die. This can cause part of the breast or nipple, or in the case of a tummy tuck, part of the belly tissue to die, resulting in a very bad outcome. Marijuana without tobacco does not cause this problem, or marijuana in an edible fashion. Vaporizers do not decrease the amount of nicotine in tobacco, only decrease the smoke.
2. There is carbon monoxide in both tobacco smoke and marijuana smoke. Carbon monoxide decreases the oxygen carrying capacity of hemoglobin in the blood. This is different from the vasoconstrictor effect, but has the same result of having the risk of tissue death in conjunction with surgeries that decrease the blood flow to tissues such as breast lifts and tummy tucks, as opposed to an augmentation alone that does not decrease blood flow to as great of an extent. Again, edible forms of marijuana do not have smoke, and thus carbon monoxide poisoning.
3. Coughing. Both tobacco and marijuana smoke disrupt the lining of the lungs and bronchi and can lead to coughing episodes. Coughing episodes can lead to internal bleeding after surgery that can lead to hematomas and complications, and again a bad outcome. Again, edible forms of marijuana does not have this effect.
4. Anesthesia effects. Marijuana can have drug interactions with certain anesthetic drugs. Thus it is important to tell your anesthesiologist about your marijuana use.
In conclusion, Smoking, whether it be tobacco or marijuana, is detrimental to your surgery outcome. Edible marijuana is much less so, but be honest about your use with your surgeon and anesthesiologist so that you can have the best outcome. In general, you should quite smoking many weeks, ideally 6 weeks before surgery, and not smoke for at least 2 weeks after surgery.
Best wishes,
Pablo Prichard, MD

Wound healing problems after breast reduction

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Thank you for the photos.  It appears that you have wound healing problems after a breast reduction or breast lift.  Many factors combine to contribute to wound healing problems.  It is true that tobacco use can hurt the healing process.  At this time you may benefit from debridement of non viable tissue, further reduction of breast size, and either partial closure or full closure of wounds over a drain.  Discuss these with your plastic surgeon as prolonged open wounds are obviously painful and cumbersome.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 170 reviews

Wound healing problem after breast surgery

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Your photos resemble a breast reduction or lift rather than an augmentation.  It is certainly true that smoking can result in wound healing problems.  The real issue here is that you need immediate attention to help you heal.  Have you sent these pictures to your surgeon? If you really do have an implant, it should be removed.  You could benefit from hyperbaric oxygen, local wound care, and more surgery to remove dead tissue.  Tissue cultures would also be useful in case you have an infection. 

Wound breakdown following surgery

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I am sorry you are having this problem. Smoking can certainly cause wound breakdown after surgery. I am not sure how a breast augmentation will cure back problems. You must have a wonderful insurance policy!

Nevertheless you now need continuous and well-supervised care from your plastic(?) surgeon. He/she should be seeing you at least twice per week to orchestrate your dressings and wound care. He/she should be debriding any dead tissue at each visit and sending wound swabs for culture and sensitivities. Antibiotics may well be indicated and you may even need to be admitted to hospital. Certainly, any implants will need to be removed.

Later on, skin grafting, delayed closure and scar revisions are on the cards.

The problem with many 'chop shops' and 'doc in a box' operations is that they are not set up to manage complications such as this. If you are not the treatment you need, go and see a Board Certified Plastic Surgeon at once.

And, no, it is not normal.

J. Brian Boyd, MD
Rolling Hills Estates Plastic Surgeon
5.0 out of 5 stars 5 reviews

Is this normal?

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This is a difficult problem and I am sorry you are having to go through this. None of us like to see things like this. Being that said your pictures are more consistent with a reduction, breast lift or breast lift with an implant not a breast augmentation as you describe. Smoking increases wound healing complications up to 12 times more than non-smokers and that is very explicit in the medical literature. Being that said, quitting will help you heal much better. The picture that you show at 5 months out seems to me to still be pretty big. I do not think any surgeon in this forum would turn their patient down if this happened to them, so if yours is denying you then just seek another opinion. If you were my patient at this point I would likely offer placement of a skin graft. Covering the raw surface with skin can reduce your discomfort remarkably. Since non of us can really appreciate this without seeing it we have all seen similar wounds at some point in our careers as residents or in practice. This needs to be cleaned up most likely and whether or not your surgeon feels continued dressing changes or coverage with a graft is up to their expertise. Make sure you go see your surgeon ASAP so they can help you. Best of luck!

Is This Normal? What Do I Do if my Plastic Surgeon Won't Help Me? (photo)

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Your story and posted photos are impressive to say the least! Seek immediate care as in a doctor who will see you at least twice a week. Have any implant removed if there is one. Seek hyperbaric oxygen therapy and possible skin grafting. You need care now! 

Breast reduction and smoking

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Smoking increases the risk of complications and this can happen with breast reduction flaps.  Usually conservative management with frequent dressing changes is the treatment if there is not infection.  Follow your surgeons instructions carefully.

Wound Healing Problem after Breast Reduction?

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I'm sorry to hear about the complication you are experiencing. These types of wound healing problems can occur after breast reduction or lifting surgery. Dressing changes and/or surgical intervention may be necessary;  therefore,  relatively urgent follow-up with your plastic surgeon is indicated. It is very unlikely that he/she will not “help you”. If this is a case, however seeking consultation with another plastic surgeon will become necessary.

Best wishes.

Complicated breast reduction

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It appears that you have very significant wound problems with possible infection and loss of fat tissue (fat necrosis) within the wound. Such serious problems require continuous care so see you surgeon right away. If true that he will not see you, you will need another to step in and help you through.

Breast Surgery Complication

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It appears that you had either a breast reduction or breast lift, not an augmentation.  You have some tissue necrosis present that can be caused by smoking.  Regardless of the cause, you should have your surgeon see you or if not, see another board-certified plastic surgeon for treatment.

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.