Black/purple spots on scar line 12 weeks post breast reduction. Is this common? Could the nipple be dying?(photos)

Question

I had a breast reduction going from a 34 double H to a 34 double-D approximately 3 months ago. I have all of a sudden developed a spot along the scar line around my left nipple. Previously on my right breast I had a dark pink spot that seemed soft and then turned into a scab which has mostly healed. I'm not sure if this is the same thing, as this look darker and similar to a blood blister. Is this common? Could the nipple be dying? Thought I was finally in the clear!

Raffy Karamanoukian, MD, FACS · Answer

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars. 
 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Daniel Barrett, MD · Answer

Dear Ledz3p,
I understand your concern. Based on your photos, this is probably caused by sutures under the skin. However, without a proper assessment it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment. Only after thorough examination you can get proper recommendations and advice.
Daniel Barrett, MD

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Jon S. Wilensky, MD · Answer

Black or purple spots along the scar line 12 weeks post breast reduction surgery can be concerning, and it's important to have them evaluated promptly by your plastic surgeon. While it's not possible to diagnose the specific cause without a thorough examination, there are a few potential reasons for these spots:
1.	Bruising: It's not uncommon to have residual bruising along the scar line for several weeks after surgery. However, bruising typically resolves over time as the body heals. If the spots are indeed bruises, they should gradually fade and disappear.
2.	Hematoma: In some cases, blood collections (hematomas) can occur beneath the skin after surgery, leading to areas of discoloration. Hematomas may require drainage if they are large or causing discomfort.
3.	Necrosis: Necrosis refers to the death of tissue, and if the blood supply to the nipple or surrounding tissue is compromised, it can lead to tissue necrosis. This can present as darkening or blackening of the skin, and it's a serious complication that requires immediate medical attention.
4.	Infection: Infections can also cause changes in skin color, including black or purple spots. Signs of infection may include increased redness, warmth, swelling, pain, or discharge from the incision site.
Given the potential seriousness of these symptoms, it's crucial to contact your plastic surgeon or seek medical attention promptly for further evaluation and management. Your plastic surgeon can assess the condition of your scar, nipple, and surrounding tissue to determine the cause of the spots and recommend appropriate treatment. Depending on the underlying cause, treatment options may include observation, wound care, antibiotics (if infection is present), drainage of fluid collections, or surgical intervention if necessary.
While it's natural to feel concerned about changes in your scar or nipple appearance after breast reduction surgery, seeking prompt medical attention can help address any potential complications and ensure optimal healing outcomes.

Genevieve F. Caron, MD · Answer

Thank you for your questionFrom what I can see on the picture you seem to be healing quite nicely. Most of the time what you describe is due to a reaction to a suture. Your body is trying to resorbe the suture. It is not uncommon that patient present at 2-3 months with a raised scar or even stitches abces (no infection). I wouldn't be worry about your nipple dying.Please follow up with your surgeonBest Wishes
Dr Genevieve F.Caron, Board Certified Plastic Surgeon
Montreal, Canada

Tarek V. Copty, MD, FACS · Answer

Hi,
Congratulations, your result is a very nice one. 
This small purple spot is most likely related to a suture that has not dissolved yet and may have collected blood around it. 
Visit your plastic surgeon to make a small incision and take out that suture. It will heal fine a few days after that. 
Best wishes, 
Tarek V. Copty, MD FACS 
American Board of Surgery 
American Board of Cosmetic Surgery Jordanian Board of Plastic & Reconstructive Surgery Fellow, American College of SurgeonsFellow, American Academy of Cosmetic Surgery Fellow, International Society of Aesthetic Plastic Surgeons

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