Can this really reattach? I understand this is necrotic from talking to my doctor. (Photo)

Question

On October 18th I had nipple reconstruction (I had my double mastectomy/reconstruction May 5th and finished radiation July 13th. When he took my nipple covers off I had two very dark brown large mounds initially. We have talked about how that was indicative I would lose some tissue, etc.. NOW, this is what my right nipple looks like. A big booger. I understand this is necrotic from talking to my doctor. Last night it finally came off. My doctor says it can heal, but I have no idea how.

Jennifer Lauren Crawford, MD · Answer

Unfortunately mastectomy surgery and radiation can be very damaging to tissue and wound healing problems as well as loss of tissue are possible consequences.  Totally dead (or necrotic) tissue will not revive and will turn black and scab off or be debrided off at some point.  As surgeons we often wait to let the tissue declare itself and let the body begin to do its own healing.  For small areas, we often manage things with dressing changes and let things heal as the appearance of tissue (long term) can often be better if we just leave things alone initially.  Skin and tissue often remodel and any remaining nipple/areola tissue may actually look quite normal after enough time has passed and the area has healed.  But, eventually you may need a small, revision surgery if you and your surgeon are ultimately disappointed and there is a surgery that could help.

Daniel Barrett, MD · Answer

Dear Crittcuddler,it is hard to tell for sure without an examination. I would suggest you to discuss this with your plastic surgeon. Only after a thorough examination you will get more information and recommendations.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Rachel Streu, MD, FACS · Answer

I'm sorry you're experiencing complications of your breast reconstruction. Unfortunately, skin health is not as good after radiation and risks of necrotic skin with operations like nipple reconstruction are higher. The good news is that the body is amazing at healing open wounds from skin loss and replacing it with a scar and new skin , it just takes time and dressing changes. Please follow closely with your plastic surgeon, as they will be the best source of information regarding your progress in healing and options as you move forward. Good luck to you.

Curtis Wong, MD · Answer

and with good wound care, its anticipated the hole will fill in and as it does, it will pull down on the flap you are holding up and eventually, secure it back on the mound.  If the hole does not fill in with good wound care, that would be concerning.

Anthony J. Taglienti, MD · Answer

Thank you for your question. Unfortunately, things like this can happen - especially if you have had prior radiation. I would listen to your Plastic Surgeon. It should heal, however you may need additional surgery in the future or a small revision. Best of luck!

Can this really reattach? I understand this is necrotic from talking to my doctor. (Photo)

Answers (5)

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