2 days after lift & augmentation my right nipple turned black & was a total scab. Can this heal & look normal over time? (photo)

I too am sorry this rare (<1% of patients, unless you are a smoker or exposed to second-hand smoke, where the risks jump to 15-20%) complication has occurred. This is dead tissue due to lack of circulation. The depth of the skin loss is impossible to determine, but those of us who have seen this know that a "normal nipple" is not "under the scab." The scab is the dead skin, possibly partial thickness, but likely full-thickness based on your photos.The good news is that once this scab separates (or is debrided surgically under local anesthesia), the resultant wound will heal, and the scar can be replaced with a reconstructed nipple/areola complex, just as we do for breast cancer/mastectomy patients. The reconstructed nipple/areola complex is not "original equipment" but is your own living tissue that looks almost identical to the opposite side.For now, your surgeon should be following your progress closely. This is neither your surgeon's nor your (unless you are a smoker) "fault," and this will heal over the next few weeks. Silvadene, Nitrofurazone, or simple wound care (clean and dry is good; daily antibiotic ointment can cause allergic reactions that can worsen scarring) are all appropriate options. Follow your surgeon's advice, and be aware that surgical debridement (removal of the dead skin and scabbing) can actually hasten and improve healing when performed appropriately and at the proper time.Once the scarring is soft and all wounds healed and supple, reconstruction can be discussed. I'd recommend waiting for at least 6-12 months. The present wound will heal over several weeks with ongoing care. Hang in there and enjoy what will eventually be a fabulous result, albeit with an unexpected "detour." Best wishes! Dr. Tholen

Thanks for the question and photos.  I'm sorry you are having this problem.  Even in the hands of the world's best Plastic Surgeon, there is a risk of nipple death after a breast lift, especially with implants.  It appears that you have partial or complete loss of your right nipple/areola.  It is best to let the scab fall off on its own, that way any living tissue isn't removed.  This will take several weeks to heal from, but the end result may still be acceptable in time.  I would stick with your Plastic Surgeon and work together for the best possible outcome.  Best wishes!

This a known complication with the type of procedures you had performed. The nipple/areola complex is very hearty and many times with conservative wound care can recover almost completely. The recovery can take several weeks  and there may be some residual scarring that may need to be addressed once all healing is complete. Continue to follow your surgeons directions and keep your follow up visits with him. Be patient this area will heal better that you might expect given its current appearance. Best of luck ,Greg Pisarski MD FACS

I am so very sorry you have this severe complication of complete nipple/areolar necrosis. Only reconstructive surgeries can repair this issue... 

I am very sorry to hear of your troubles.  At this stage conservative wound care is in order like your plastic surgeon is doing.  Keeping the area from getting dry will  preserve any remainng viable tissue. In our practice we use either Bactroban or Silvadene, but do follow you surgeon's advise foremost. He/she has your best interests in mind.  Hang in there as this may take several months to finally heal. 

I am sorry that you are going through this unexpected and rare situation. Your surgeon is doing the right thing and this will take time to heal. The healing process may take few months and your surgeon is your best acesst.

Your right nipple is not going to make it.  It has very poor blood flow and is acting as a biologic dressing.  It will likely need to be debrided (excised and cleaned up) and hopefully local wound care will not cause the implant to be affected or exposed to the outside world.  If the implant is affected and isn't covered by healthy tissue, it will need to be removed.  This is something that you can come back from, but I want you to be prepared.  That nipple will need to reconstructed and tattooed to match the other side.  Right now, the important thing is to stay calm and follow your surgeon's instructions which should be to keep clean and covered.  I am sorry this has happened.