Is yellow drainage a normal part of the wound healing process after a Breast Augmentation? (photos)

Question

My incision tore in the junction under my right breast after an anchor lift. Surgery was done on Aug2 and the tear developed a few weeks after. I have been keeping the wound moist with aquaphore and occasionally applying gentamicin. I use gauze or a folded maxi pad to cover the wound, bc my skin is sensitive to adhesives. Does it appear to be healing just fine or should I be concerned about the yellow discharge/mucus residue left behind? Is this present bc of an infection or bc I keep it moist?

Gary Lawton, MD, FACS · Answer

This is not a regular breast augmentation.  This is the result of combining a lift with an aug.  A lift with an implant is controversial for two reasons.  First, when you perform a lift you are making everything tight and closing the wounds under tension.  It you add the expansive forces of the implant at the same time, you are fighting against yourself.  There are forces on the wound which try to make them separate, which results in wider, thicker, more irregular scars.  In the worst case, the wounds will open.  So compromises are usually made in the operating room by the surgeon because they cannot close the lift wounds over the appropriate sized implant.  Either less of a lift is performed so that the skin is not as tight and therefore there is less tension on the closure.  Or a smaller implant than would be appropriate is used so as to decrease the expansive forces.  Either way, you are compromising the aesthetic outcome.  Often the outcome is so compromised that a second revision surgery is required.  If however, you plan to have the lift first and then the augmentation after everything has healed, then you have two operation that are planned, both with much lower risk than the combined mastopexy/augmenation.  The outcomes of the two meticulously planned operations are much better and a more aesthetically pleasing, and a safer outcome is achieved.

The second reason the combination of mastopexy and augmentation is controversial is because of the risk of nipple necrosis (death of the nipple).  By making the skin tight for the lift, you are putting external pressure on the veins that supply the nipple.  By putting an expansive force on the undersurface of the breast with an implant, you are putting pressure on the thin walled veins that supply the nipple.  If the pressure by squeezing the veins between the implant and the skin is greater than the venous pressure in the veins, the flow will stop.  If the venous outflow stops, the arterial inflow is stopped.  If the arterial inflow is stopped, there is no oxygen for the healing wounds and the tissue dies.

Placing the implant on top of the muscle in combination with a lift puts the blood supply to the nipple at a much higher risk because in addition to the issue of pressure on the veins, you have to divide the blood vessels that are traveling from the pectoralis muscle directly into the breast (and to the nipple) in order to place the implant between the breast tissue and the muscle. This adds a third element of risk to an already risky operation.  Mastopexy/augmenation with sub glandular implant placement is by far the riskiest way to address your anatomic question.

Jerome Edelstein, MD · Answer

Hello,Delayed wound closure can occur with anchor Breast lift procedures combined with Implants. Yellowish debris in the wound and on dressings can be normal fibrous material or medication residue and a part of the healing process however you must be seen and assessed in person regularly to ensure that you are healing well with no further complications. I recommend that you meet with your Plastic Surgeon in person.All the best

Christopher T. Maloney Jr., MD · Answer

Thank you for your question and for posting photos as this makes it easier to see what is going on. It is not uncommon to have some slow healing in the "T" junction of the incisions. Everything appears normal, just slow to heal. Continue your wound care instructions that your plastic surgeon gave you. If you have increased redness, pain or get worried about anything, call your surgeon's office and they will take care of you. You need to stay on top of it and make sure you do not develop an infection with the implant. So you shouldn't worry, however if something changes you do need to be aware and let your surgeon know. Good luck and give it some time.

Naveen Setty, MD · Answer

Thanks for your pictures and your question.  Sorry to hear about the delayed healing after surgery.  Having a wound develop in this area after an anchor lift does happen.  These usually heal with local wound care.  The yellow drainage is typical with an open wound as fluid and protein are lost through the open wound.  Keeping the area slightly moist helps wounds heal.  The red tissue is a good sign of healing tissue but you may have some overgrowth of this tissue.  You may need some debridement to help speed the process.  Sometimes, antibiotics are needed as well when a wound has been open for a prolonged period of time.  Make sure you keep in close contact with your surgeon.

Vishnu Rumalla, MD · Answer

Thanks for your inquiry and pictures, but only your surgeon who is treating your wound will know if you should be worried. When there is an implant, wounds at the t-junction are a much more significant issue than a wound at the t-junction with only a lift.  Please have your surgeon comment.

Sam Jejurikar, MD · Answer

Unfortunately, breakdown at junction of vertical and transverse incisions can happen with breast lift. Examining your pictures, your wound is definitely improving with local wound care. The yellow material in your wound appears to be fibrin, which is a thick protein present in almost all healing wounds.I would continue to follow the dressing change regimen recommended by your plastic surgeon, as it appears to be working.All the best - Sam Jejurikar, MD

Christopher J. Davidson, MD, FACS · Answer

Thank you for your question and photographs.  It would not be my advice to keep this area moist.  I strongly recommend that you follow up with your plastic surgeon and follow his/her instructions.  Best of luck.

Ven Erella, MD · Answer

Thank you for your question. Look like it is healing well. Please continue with local wound care per your PS and follow instructions.

Connie Hiers, MD, FACS · Answer

I would suggest that you have your surgeon examine and culture the wound. You don't want to risk an infection with implants.

Ravi Somayazula, DO · Answer

Sorry to hear about the delayed healing you are experiencing. Your pictures demonstrate healthy red granulation tissue which is a sign that things are healing. Proper wound care as instructed by your surgeon is important to ensure timely healing. The yellow is subcutaneous fat which is normal. Close follow up with your surgeon is important to ensure no signs of infection and timely healing.Best wishes,Dr. Ravi Somayazula

Is yellow drainage a normal part of the wound healing process after a Breast Augmentation? (photos)

Answers (13)