Is my Free Nipple Graft Failing? (photo)

Question

Hi. I've recently had a double mastectomy. I'm FTM transgender. I'm three weeks post op. The doctor cut 3cm wide nipples and put them into 2cm wide 'holes', as they were 'supposed to shrink'. Left one did, but right one only shrunk a little and then got 'droopy'. It'd bleed a little from the underside and some from around the actual nipple (brownish). Now, the upper part cracked and I think I can see my flesh underneath. I'm freaking out big time. My doctor is not seeing me until Monday. Help.

Jed H. Horowitz, MD, FACS · Answer

If you recently underwent Top Surgery,then it is still very soon into your #healing. Therefore, your incisions and #nipples will go through a maturation #process. For the first few months they will be red and possibly raised and/or firm. As the scar matures, after 6-12 months, it becomes soft, pale, flat, and much less noticeable. You may experience numbness, tingling, burning, “crawling”, or other peculiar sensations around the surgical area. This is a result of the #healing of tiny fibers which are trapped in the incision site. These symptoms will disappear. Some people are prone to keloids, which is an abnormal scar that becomes prominent. If you or a blood relative has a tendency to keloid formation, please inform the doctor.
Bruising and #swelling are normal and usually increase slightly after the removal of any tape or foam. The bruising will decrease over 3-4 weeks, but may last as long as 6 weeks. The majority of the swelling will be gone within the first 3-4 weeks. However, it may take 6-9 weeks to disappear completely. Also, as you heal, the area may feel “lumpy” and irregular. This, too, decreases with time, and massaging these areas will help soften the scar tissue. The #compression garment helps reduce the swelling, and the longer it is worn, the more quickly you will #heal. It can also assist in the retraction of the skin. If you have any concerns about #healing, its best to ask questions of your surgeon or their nursing staff.

Gary J. Alter, MD · Answer

It is difficult to say. However, even if it failed partially or completely, you can always get medical pigment tattooing, so don't worry.  See your doctor. There is nothing to do at this time anyway.

Michael S. Beckenstein, MD · Answer

Unfortunately, it appears that the majority of your graft has failed. Don't panic, be patient it will heal up over the next few months and some revision all procedures can be done, including skin grafts, scar revision, and possible tattooing. Make sure you see your surgeon ASAP!

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.Please follow up with your PSThe best way to assess and give true advice would be an in-person exam.Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.best of luck!Dr Schwartz

Gary Lawton, MD, FACS · Answer

Nipple grafts can have this appearance after double incision mastectomy.  Typically we use silvadene cream on the grafts from the time the dressing are applied in the operating room until they are fully healed.  If yours have been left dry, like it appears they have, it might separate, and the resultant nipple may be smaller than it may have otherwise been.  There is no need to panic however.

Richard A. Bartlett, MD · Answer

It is hard to tell from your photo but is looks like some part of the graft didn't take.  I would let your doctor know immediately so that they can make specific recommendations regarding care of the site.  Even if you loose the nipple a new one can be made.

Christopher J. Inglefield, MBBS, FRCS(Plast) · Answer

Hi Charlie.  Very sorry to hear that you are anxious following your mastectomy with free nipple grafts.  Your photo does show some separate at the edge of teh nipple graft with is very crusted.  Make sur eyou get your surgeon to look at this carefully and advise you on how best to look after the nipple graft.  You may require some revision surgery once healing is complete but priority now is to get this healed up.  Good luck and if you cna post a follow-up photo, that would be very helpful for other patients.

Sheldon Lincenberg, MD · Answer

When a nipple graft fails, the loss of the natural nipple and areola can be replaced with a reconstructed nipple and areola. Current techniques give very real-appearing nipples with a surgery that is done in the office under local anesthesia . The areola is simulated with a tattoo. Some tattoo artists can are so skillful that they can create a 3-D appearance of a nipple, which makes the nipple reconstruction surgery unnecessary, however the 3-D nipple tattoo will not project forward to give a natural appearance in a T-shirt.Hopefully, considering the date of your inquiry, you have already completed your reconstruction. My response may be of help to others looking at this question.

Josef Hadeed, MD, FACS · Answer

It is difficult to tell how viable the nipples are based on the photos you provided.  It is best to keep the area as clean as possible and see your surgeon.

Babak Dadvand, MD · Answer

Hi Charlie,Thanks for the post and photo. It appears that you are having some compromise to your nipple and areola. The black area will eventually separate and you will either have an open wound or new formed skin. Either way, the results should not be affected too much and down the line, medical tattooing can restore the color to the areola as need be. I recommend that you follow your doctor's advice as far as any creams or wound care that needs to be done.Sincerely,Dr. Dadvand

Is my Free Nipple Graft Failing? (photo)

Answers (11)

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