Stitches opened more. Am I at risk of losing my areola and nipple? Will my implant be exposed? (Photo)

Question

I posted about a week ago. Have follows all of my doctors advice and tonight realized I have further seperation and my nipple / areola is starting to "go away". I need a straight answer. Should I get a second opinion? What's next? I am so worried I am going to have ugly deformed breast.

Vishnu Rumalla, MD · Answer

Thanks for your inquiry,  the skin around the nipple areolar complex has died.  The nipple areolar complex itself seems to be viable.  My concern would be the implant getting infected, so meticulous care with your surgeon's supervision is a must.   It is hard to tell what the final result will look like, but do not consider any revisions till 6 months after everything heals, good luck.

Pejman Aflaki, MD · Answer

It looks like you have progressive wound breakdown and necrosis of nipple-areola complex. Your surgeon should assess your wound carefully and debride the necrotic areas. He/she should be able to tell you whether or not there is communication with the implant pocket, which is more likely if your implant was placed above the muscle. These wounds could be misleading; they might look superficial but in many occasions there is involvement of the implant pocket, in which case the implant should be removed. If you end up losing the implant, you should wait until your wound heals completely prior to considering another augmentation/mastopexy, usually several months down the line and in a new pocket (e.g. subglandular to subpectoral). You should be able to trust your surgeon. I would have a low threshold to seek a second opinion. Best of luck!
Pej Aflaki, M.D
Johns Hopkins-trained plastic surgeon

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.
  The best way to assess and give true advice would be an in-person exam.
I would recommend that you discuss this question with your surgeon as every surgeon has their own respective post op protocol for his/her patients.  Your surgeon is your best resource as he/she is most familiar with your medical history and how you are healing at this time.
  
Please see a board-certified plastic surgeon that specializes in aesthetic and restorative plastic surgery.
Best of luck!
  
Dr. Schwartz
  
Board Certified Plastic Surgeon
  
#RealSelf100Surgeon

Andrea Marando, MD · Answer

I am sorry to hear that the situation is getting progressively worse. Again, it is not easy to advice you just looking at a photo. If the implants gets exposed, it will have to be removed and after several weeks, when everything has finally healed nicely, a new implant will be placed. Removing the implant for an infection is unfortunately a fairly rare but possible complication.  Looking at the photo, I would advice you to contact your surgeon and his practice to be closely assisted in the dealing with the delayed healing to try as much as possible to save implant and nipple. There is always a plan A and B.Best of luckAndrea MarandoPlastic and Cosmetic SurgeonManchester, UK

Sugene Kim, MD, FACS · Answer

Dear Marmar14Sorry to see the complication after your surgery.  Based on your photos, there is partial necrosis of areola along with wound dehiscence.  The wound does not seem infected; however, it will need continued wound care and close follow-ups.  Each plastic surgeon has different wound care regimen and post-op instruction. Please follow up with your plastic surgeon closely.Best regards.

Kamran Khoobehi, MD · Answer

This is a difficult  situation for you and your surgeon. I would recommend implant removal to decrease tension on the breast tissue. Your nipple is at risk and removing the implant will allow faster healing and then you can have implant or fat grafting.

Earl E. Ferguson III, MD, FACS · Answer

Your situation is a rare and unfortunate complication of combining these procedures.  It is difficult to tell if there is infection present or just skin loss. If you feel that your surgeon is not adequately addressing your concerns, then I would encourage you to get a second opinion.  He or she should be seeing you regularly and advising you as to the best course of action each step of the way.

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