Did the use of silver silvadene cause my nipples and skin to be in this condition after my nipple sparing mastectomy? (Photo)

The cream did not cause nipple loss or skin loss. The changes that cause skin and nipple loss are the technical aspects of the surgery that leave behind blood vessels to serve the skin and nipple. I am a mastectomy surgeon and have performed successful nipple sparing mastectomies in hundreds of women. The nipples and skin did not have enough blood supply after your surgery and were not going to live. The cream was present to keep the living tissue in the surrounding area that still had blood supply healthy so that it could regenerate and heal over the dead areas. Keeping the blood supply in tact while removing the tissue that can cause cancer is a careful balancing act and is the responsibility of the surgeon who did the mastectomy (like me), not the plastic surgeon. Talking to your surgeons before surgery and knowing if they expect nipple loss and skin loss says something about their skill level at keeping healthy blood supply to the skin and nipples. If they expect the nipples to die in a certain (high) percentage of their patients or if their office says it is "common" in their patients, that says something about their surgical skill level. Not all doctors expect or have nipple loss or skin loss when they perform nipple mastectomy surgery. Patients who smoke or have diabetes do have higher skin and nipple loss rates- beyond that, it is down to what the mastectomy surgeon does for the most part. This can happen to even the best surgeons at times- but if there are many patients (say, greater than 30 to 50 percent of the people that have nipple sparing mastectomies) in your community that have had that surgeon perform the surgery, perhaps that surgeon needs to re-assess their techniques. I'm sorry you had this experience- it looks like your plastic surgeon is managing your wound healing very well! 

I am sorry you are having so many issues with your mastectomy flaps. The blood supply to skin and nipples are compromised after breast tissue removal. silvadene is given to help heal skin problems, it does not cause the problem. It has an antbacterial effect which can promote healing and prevent infection. Hang in there, it looks like you are on the (slow)road to recovery. Good luck and take care.

This can be a complicated balance between the mastectomy and the reconstruction.  Many times the mastectomy creates a significant decrease in blood flow as Dr. Richardson describes.  At other times the reconstruction can provide stress on the tissues as well. I use the evaluation of tissue perfusion in the operating room to visualize the tissue perfusion at the time of mastectomy and reconstruction.