Is this breast tissue necrosis or just a scab? (photo)

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.

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.

Hello there

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

Terrence Scamp

Yes, it is not unusual to see delayed wound healing or skin necrosis after these types of procedures.  The important point is how to manage this down the road.  There is a HUGE difference if this represents an implant case or not.  Patients having undergone a Breast Lift or Breast Reduction without implants can be managed very conservatively without much concern for the depth of the wound, time to complete healing, or to some extent the exact "status" of the wound.  These will heal eventually, perhaps with the need for a revision in the office under local anesthesia.

More critically, if an implant is in place, the status of the wound is of paramount importance as infection into the tissues or exposure of the implant can mean significant risk to the prothesis and even potential loss of the breast implant.  My suggestion is followup with your plastic surgeon who is aware of YOUR specific situation. Best of luck. 

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. 

Hi Went4it

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.

Good Luck

Dr Gavin Sandercoe

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.

It appears that you had either a breast lift or a breast reduction with a key hole pattern.  The area at the base of the inverted T is under the most tension and the furthest away from the blood supply.  It is not unusual to have some degree of wound healing problems at this point. It will just take time for this area to resolve.  If it leaves an excessive scar then it can be revised in the future.