I saw my PS on Monday and he stated he wanted to see me again in two weeks for this "scab?" After a little research on this site, it appears as if this may be more than a scab. Seems to me like it is Necrosis. Any opinions would be helpful, and also, what kind of treatment is usually used for situations like this? Should I wait two weeks or is this something that needs to be addressed ASAP. As of right now, he has advised me to do nothing until I see him again in two weeks.
Tissue necrosis? (photo)
Doctor Answers 14
Wound necrosis after breast reduction
Your photo clearly shows some tissue necrosis of your left lower breast. It appears that you have had a breast reduction with an inverted T or anchor pattern scar. This area where the lines of the T meet is the furthest away from a blood supply and also under a fair bit of tension. This is why this area is the most common point for healing problems with that technique.
The best thing that you can do at this point in time is to keep it clean and prevent any infections. Antiseptic ointment will help, as would oral antibiotics. Washing with an antiseptic body wash is another helpful method of reducing the amount of bacteria around that can cause things to worsen.
This is not a disaster, but it is a nuisance for you whilst it heals. If it heals by itself with no further problems, you will barely notice that it happened by the time the scars are mature in a year or so. Occasionally patients that have T junction breakdown do need dressings, wound support and scar revision. Make sure that once the area heals to work hard on the scar management (massage, silicone sheeting etc).
Two weeks between appointments is a bit longer than I would offer (I try to see any patients with wound problems on a weekly basis), but it is not unreasonable.
Dr Gavin Sandercoe
Skin loss sometimes occurs with mastopexy but generally is not a major complication.
The amount skin loss in the picture is substantial. Nevertheless, with careful wound treatment this should heal over time. I would guess that the area would benefit from a scar revision would is completely healed.
Clearly, this is an eschar of tissue necrosis. The best way to handle it is to keep it clean. This complication usually heals without additional treatment needed.
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It does appear that you have some skin necrosis present. The area at the "T" in a breast lift is not an uncommon area for this to happen as it has the greatest risk to the blood supply to the skin. The good news is that, even fairly large areas of skin necrosis in this area will often heal up without requiring any further treatment. It just takes awhile. Sometimes the bad area can be removed under local anesthesia in the office, however, as long as it does not become infected, I imagine your doctor will treat it conservatively like any other "scab." Eventually, it will fall off as the tissue underneath heals and shrinks. If the resulting scar is not satisfactory, it can usually be revised under local anesthesia in the office.
I am not sure what procedure you had (?lift =/- Implants). This area in the photo is the furthest away from its blood supply, and most likely to suffer necrosis, as you correctly have figured out.
Although not an emergent problem, regular follow up is advisable, especially if there are implants present.
At some point the non-viable skin will separate, or will be trimmed by your surgeon, and typically will heal underneath, often uneventfully, occasionally with a wider scar than hoped for. In the latter case, it can be revised often in an office setting with local anesthesia.
All the best.
Each surgeon practices in their own way. For me I would follow you daily with wound care therapy. Possible aggressive debridement and PRP treatments.
You are correct in your assessment and should see your PS on a regular basis but this situation is NOT an emergency. This type of necrosis is usually a self-limited process that has to run its course. Some surgeons prefer to let the necrotic tissue fall off while others excise the tissue and start patients on dressing changes. In any case, the area will eventually heal and if needed you can have a scar revision to improve the appearance of that area. In the meantime, be patient and follow your surgeon's instructions...
In the absence of infection there is no urgency to intervene and the area can be observed . The human body has a remarkable ability to heal itself and you may well be surprised at how well this area resolves .
It does take time , however .
Keep the appointment your plastic surgeon has made for you but let him know sooner if the area becomes red and painful .
All the best
Full thickness wound healing problem after breast surgery
It looks like you have a small area of full thickness skin loss.
This isn't a huge problem (as long as you didn't have a simultaneous implant placement as well) and should heal spontaneously over a period of weeks.
Optimal wound care is essential to minimize scarring but even if the eventual scar is wide or tight a scar revision should have the area looking good.
Your Plastic Surgeon should be able to advise you about the best way to look after the area.
That area in an inverted T skin reduction has the most tenuous blood supply therefore highest risk of necrosis. After you get necrosis a "scab" forms, so they are pretty much the same thing.
A dry scab is the best dressing we have, hence it is called a biological dressing. It would be a different story if it was a "wet scab" i.e. it was weeping, in that case you would need an operation to clean away the necrotic (dead skin)
Your surgeon is absolutely right leave it alone and let the skin underneath heal. There is no rush to intervene just yet.
Hope this helps and good luck.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.