Treating fairly superficial post-op wound dehiscence at inverted T junction after breast lift and augmentation?

Question

I had a mastopexy and augmentation on 3/9.On 4/8, slightly above the inverted T junction,the incision started to open up and I've since had multiple "spitting" sutures removed.It's approx the size of a quarter and is fairly superficial.It was cultured and I was put on abx.The wound now looks clean, but there is no visible improvement.My surgeon had me apply Silvadene BID,but when I f/u with his partner,he said to do wet-to-dry dressings.Any advice on the best way to treat and speed this up?

Joel M. Stewart, Jr., MD · Answer

This is all too common and usually this will heal very favorably.
Eating a diet with plenty of protein and taking a one a day vitamin are all that usually is required.
Patience during this time is difficult, but it looks like you are on the right track for healing.

Robyn Daugherty, MD · Answer

Hi LiftMom - 
Wounds heal best in a slightly moist environment.  I would keep the wound clean (showers 2x daily and no tub baths or swimming pools), apply a thin shiny layer (not goopy) of bacitracin ointment and cover with a bandaid.  Also, since you have an implant in place, I would be seeing you or at the very least have a nurse seeing you and taking photos of progress weekly until you are completely healed.  The worst possible situation at this point is that the wound progresses and you have infection and impending implant loss.  Best of luck!  I hope you are healed soon!

Richard J. Brown, MD · Answer

Ok BritMom here is the deal. This unfortunately happens often with this kind of surgery. The skin in that area after this operation is where the blood supply is the worst. The good news is there is no issue with the implant and there is no infection  noted. That would the the one thing with an implant that keeps me on high alert with you and I would want updates often on how you are doing. With no implant I don't worry so much because implant infection can be gnarly. But, here is all you need to do. Having done tons of burn surgery you do not need silvadene here. That really is overboard in this situation. The other two options are the one his partner told you, or just go buy antibiotic ointment and use that on a non-stick bandage each day. DO NOT USE NEOSPORIN!!!! It is the worst possible thing for a wound because many patients had an allergic reaction to it and it makes the wound appear worse. I would do dressing changes 2-3 times a day. I would wash it with soap and water and do not get in a swimming pool. Shower is fine. It will heal and the way these usually go is they are pretty slow for the first 2-3 weeks them bam, they take off and heal pretty quick. Patience is the virtue here. Keep it clean and keep it in a moist environment. I like non-stick bandages with antibiotic ointment 2 times a day for these wounds. My patients get them and that is how I treat them. I worked in a wound healing lab for a year in residency and obviously am a wound specialist as a plastic surgeon. So if you do these things it will heal. But, any signs of spreading redness or warmth to the breast let your surgeon know immediately to rule out implant infection.DrRickAZ

Brooke R. Seckel, MD, FACS (retired) · Answer

This superficial skin loss is common at this junction following breast lift with implants.   These wounds are superficial and yours is clean and should re-epithelialize with new skin over the next 4-6 weeks.  My preference for these wounds this wet to dry dressings to remove dead tissue that appears quite or yellow.  Once the wound is completely red thin layers of ointment may be used.

Treating fairly superficial post-op wound dehiscence at inverted T junction after breast lift and augmentation?

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