Mastopexy with Implants Incision Separation, How Much is Too Much? (photo)

Open areas like this can be very common after breast lift surgery. These areas can take a long time to heal so be patient. They are difficult and risky to close because of the risk of infection and tension on the incisions and inflammation around the skin edges. It is best to let everything heal and then consider a scar revision 6-12 months down the road, when the scars are no longer pink and the tissues are soft. Surprisingly, many open wounds like this heal well over time and don't require scar revision.

Your pictures demonstrate wound separation along both the transverse and vertical limbs of your breast closure. Unfortunately, wound separations aren't unusual following this type of procedure for a variety of reasons.When patients undergo breast augmentation in combination with breast lift surgery, skin flaps are wrapped around a central pedicle of breast tissue that supports the blood supply to the nipple areola complex. The area where the transverse incision meets the vertical incision is at significant risk for breakdown because the flaps in this location may have poor blood supply. In addition, the weight of the pedicle and breast implant may exert significant downward force upon the closure where its weakest because of poor blood supply.Wound separation following this type of procedure usually heals nicely with local wound care and dressing changes. It's not unusual for minor bleeding to occur with dressing changes as debris is removed from the wound surface. In most cases, healing is complete in 4 to 6 weeks, but this may vary from patient to patient. In a small number of cases, secondary scar revision may be necessary at a later date.Even when patients who undergo the combination of breast augmentation and breast lift have areas of wound separation, the clinical results following this procedure are excellent. After wound healing is complete, levels of patient satisfaction are high as well.

If the area is not healing with your current wound care regimen, I would suggest changing. Properly treated wounds in healthy patients should get progressively better with time and should not be static. I would suggest changing the silvadene dressings to a simple saline moistened gauze changed 2-3 times a day. Unless the skin is very thin, the wounds should heal and you should be able to revise the scars 3-4 months after the wounds have epithelialized. 

Thank you for your photographs.  Closing these wounds is not the right answer.  Local wound care is the answer but this is a slow process.  Healing will occur over many weeks and leave a scar that can be revised typically in several months.

Dr ES

This large a wound this far after surgery may be too much. The usual for smaller openings at the "T" incision is to allow it to heal with local wound care alone. (I have answered several such questions at this sitting.) However, in the presence of implants, which wounds so large and so long after surgery, I would consider skin grafting these to get the wounds healed before the implants get infected. 6 months down the line, consideration will undoubtedly be needed to improve the appearance and to remove the skin grafts and replace with breast skin. But a major revision will be needed anyway if this is allowed to heal without surgery. 

I would consider a second opinion whenever possible for you. All the best. 

 I am sorry to hear about the complication you are experiencing. This type of complication, unfortunately does occur after breast augmentaion/lifting surgery. It tends to be anxiety provoking for patient and plastic surgeon as well. The concern, as you know, is that there is an underlying breast implant that can potentially become exposed, usually necessitating removal.

 How far away from the surface is the breast implant is best determined by your plastic surgeon who knows your situation best. Continue to follow up closely with her.

 Best wishes; hopefully the current course of treatment will be successful.

The risk of wound separation post lift/augmentation is high and not unusual. Your separation is more than usual and you may had necrosis too. The best treatment is wound care and you will be fine. You may need revision in 6-9 months. 

This is very unusual.   Seek a second opinion as soon as possible. You want to avoid infection, and start the road to recovery.