Necrotic Nipple (Size of Baseball) Due to Radiation. What Can Done Besides Surgery? No infection. Just dead tissue

After Double masectomy,(nipple sparing, used alloderm, immediate implants) have nacrotic right nipple and below. (size of baseball) for 16 weeks due to radiation 5 yrs ago. 37th Hyperbaric Chamber appt. tomorrow. What else can be tried? Please help, only thing being offered is surgery to remove implant and nacrotic tissue, wait 6 months, insert expander, wait 6 mos, then try again with no guarantee it won't happen again. No infection. Just dead tissue. Any Ideas?

Doctor Answers 4

Breast Reconstruction

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Skin necrosis (dead skin) after radiation and surgery, will need immediate surgery, where all necrotic tissue and severly injured radiated tissue including bone (if infected) need to be removed and immediate chest wall reconstruction with a good vascular flap. The Latismus Dorsi myocutaneous flap fits this description. The implants you still have , will need to be removed if there is any hint of contamination or infection.

Baltimore Plastic Surgeon

Radiation in reconstruction

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In the setting of radiation, an expander/implant reconstruction will have a significantly higher complication rate.  In your case, you can still have a successful reconstruction with a tissue flap.  Either latissimus, TRAM, or DIEP are good options. 

Nipple necrosis after nipple sparing mastectomy and radiation

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If indeed your nipple is black and necrotic, then you will need it debrided and removed.   If there are no signs of infection, your surgeon may be able to salvage your implant reconstruction but may need to downsize your implant.  This may lead to a significant asymmetry.   Your PS plan's to remove the implant and come back and fight another day also sounds reasonable.

Necrotic nipple after radiation

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Hard to say what is best for you without an exam inperson, but if the tissue is necrotic it sounds like it needs to be debrided( cut away).  It is best to see your surgeon. Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

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