Is this necrosis? (photos)

Question

I had prophylactic bilateral mastectomy with immediate one step reconstruction ( strattice and silicon implants) 19 days ago. My right breast developed a hematoma the day after surgery and I had to go back to the operating theatre to be opened up again and have this fixed. I also developed a seroma on the same recon breast. My question is do I now have necrosis? I saw the surgeon 4 days ago and he said blisters had developed on wound, but now it looks sore of dark brown black. Is it necrosis

Dallas Buchanan, MD · Answer

From your pictures, it does appear that the blood supply to a portion of your mastectomy flap is inadequate and this has led to some necrosis of the mastectomy skin flap. Sometimes, wounds such as this can heal with local wound care as they are only partial thickness necrosis. With breast reconstruction on the other hand, there is an implant beneath that area, so one has to be very careful about opening of the wound and exposure of the implant. Some surgeons in this case would favor aggressive management with excision of the necrotic area and repeat wound closure. I would strongly advise you to see your plastic surgeon sooner rather than later and discuss with them the options for treatment that he or she feels are in your best interest.

Mahsa Moghaddam Smoot, MD · Answer

Thank you for providing photographs with your question. It's very helpful! Based on the images you do have necrosis of the skin flaps. Please contact your plastic surgeon today to be evaluated sooner rather than later. With an implant based reconstruction you are at an increased risk of developing an underlying infection. I am sorry that you've had so many difficulties with your reconstruction so far. I wish you the best!

Khashayar Mohebali, MD, FACS · Answer

Unfortunately based on the picture it does appear to show some level of necrosis of your skin. I would follow up with your surgeon and see what they recommend to do.

Samir Shureih, MD · Answer

Based on the pictures posted, there is skin necrosis. With a silicone implant and Strattis, this need to be revised urgently before there is infection

Max Gouverne, MD (retired) · Answer

Beth, thank you for your question, you have a legitimate concern and you deserve an answer to your problem.Thank you for your pictures.It does appear that your wound is not healing well, so please see your surgeon. He'll tell you that there is at least some superficial breakdown. Frequently this can be managed with simple dressing changes but occasionally these wounds may progress to a full thickness loss.Infection is the one thing you may want to avoid as an untreated infection can lead to removal of the implant.Again, Beth go see your board certified plastic surgeon and he will guide you to the next step. Please let us know how your reconstruction turned out.

Is this necrosis? (photos)

Answers (5)

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