Good afternoon, Exuberant9650. Thank you for sharing your photo and your concerns. In looking at the picture, it appears that you have experienced nipple and areola necrosis, and the wound is in varying phases of healing and slough. The pink, velvety tissue is actually the healthy healing tissue, called "granulation." The yellow/yellow-white waxy looking stuff is "fibrin" -- this is the fibrous substance that non-viable tissue will convert into. Once this fibrin separates and sloughs, the body will then begin filling in the wound with the granulation tissue. The black, scabby appearing tissue is an "eschar." This is basically non-viable tissue scabbing. What lies underneath may be healthy, healing tissue, or may be marginal, necrotic, or fibrin tissue. The body will also steadily begin to separate the eschar.The gauze pulling off the fibrin or eschar is actually a good thing. This is called "debridement." Debridement can be performed cell layer by cell layer by the wound dressings, or in larger pieces through cutting or surgical excision. The gauze sticking to the granulation tissue is less desirable, but not horrible. There are a variety of non-stick options -- the pad of a large Band-Aid, a dressing called Telfa (or Curad is another brand), petroleum (Vaseline)-coated strips, perforated silicone sheeting (Mepitel), etc. However, a dressing that is too occlusive will also keep the wound to moist, that may promote bacterial growth, and may reduce the debridement of the non-viable tissues. Adding a Vaseline/petroleum-based ointment to the granulation tissue (Vicks, antibiotic ointments -- watch Neosporin as the sulfa can cause redness that may look like an infection; also, Bactroban, that requires a prescription, is a probably the most effective antibiotic ointment and will provide coverage against some of the more aggressive bugs, Aquaphor, or plain-old Vaseline) can provide a relatively non-stick protective layer. Moist to moist dressings, if changed more frequently, will also reduce sticking.Each surgeon has his/her own special wound care formula, based on his/her experience and training. I would express your concerns to your surgeon, but follow his/her regimen closely. Best of luck, and hopes for quick healing! Dr. Ghafoori
