Follow-up: update on breast. Is this necrosis? Will I need a skin graft to try to finally look normal? (Photos)

Yes, you have some necrosis of the nipple-areolar complex. In the case of a breast reduction, this is a well recognized complication and the recommended treatment is to manage it conservatively with dressings, as you are doing. You would expect it to heal with a slightly widened scar, which could be revised later. The situation is more complicated if an implant is involved. Here, the danger is of the surface bacterial contamination of the necrotic wound gaining access to the pocket containing the implant. Once this happens, the implant will need to be removed. For this to happen, however, the necrotic tissue would likely reach all the way down to the implant. If there is healthy tissue between the wound and the implant then the conservative management might work here too. I wish you luck.

Thank you for the pictures and questions. I am very sorry to see you are having this type of complication. This is definitely necrosis related to lack of blood flow to the tissues. As you have probably already figured out, these wounds tend to look worse before they look better as the true depth of the tissue death takes some time to reveal itself. Although there are no signs of gross infection in the pictures, there is some fibrinous debris that is part of the healing process that could probably benefit from some debridement. Other than that, the trick is time and local wound care. Just continue to keep the area clean and follow your surgeon's instructions for wound care. It is a good idea to see him or her on a regular basis to follow the wound. If there is an underlying implant, you need to make sure the implant does not become exposed or infected.As for the question about the skin graft the answer is no. A skin graft for a small wound like this would not be ideal and would lead to a more unsightly end result than just letting the wound heal on its own. Once the wound heals completely, you will be left with a wide, contracted scar in this area which may be amenable to a scar revision in the future. But, I would not consider doing any kind of scar revision until at least one year from the time the wound heals. In the meantime, you can discuss with your surgeon things you can do for optimal scar management. Hope this helps!

Hello,This is a combination of necrosis and separation of the incision (dehiscence). This wound needs debridement, however if the implant becomes exposed you'll need it to be removed. Replacement should not occur until full healing, about 3 to 6 months. Best of luck.

It is good that you are continuing to see your plastic surgeon on a regular basis.  I would recommend you continue with your wound care regimen as recommended by your surgeon.The wound over time will contract and get smaller as it begins to fill in over time.  It will require some time, difficult to say how long, so patient and frequent follow ups are needed.Hope that helps.

From the looks of it, it seems that there were some wound healing problems.  I don't know why you had this problem but I recommend that it should be to debrided  and local wound care should be implemented. A board-certified plastic surgeon should be very competent and familiar on how to fix this. 

Dear pinkerz123,I'm sorry to hear about your problems and it is good that you are in touch with your plastic surgeon. I would suggest you to continue following his instructions. In most cases this type of wounds heal from the inside out. It takes a longer period of time to full heal and there might be a bigger scar. Daniel Barrett, MD, MHA, MS
Certified, American Board of Plastic Surgery 
Member, American Society of Plastic Surgery

and then you need to allow the scar to mature as it will continue to improve with time.  6 months to a year after you are healed, your scar is evaluated and you will get options on what to do then.  This could be scar revision, skin grafting, or even as simple as tattooing.  Be patient and wishing the best for a decent outcome.

What yo need is aggressive dressing changes and serial debridements and antibiotics that are guided by a culture. If managed properly, you may not need any further surgery.