I had a DI mastectomy 11 days ago. I know nipple grafts normally scab over but they've started oozing and bleeding more and when they flake what's underneath doesn't seem right. The doctor I spoke to confirmed that it does seem like my grafts didn't make it, and that there isn't anything to do for now. If this is indeed the case, what should I expect? Will I be met with bloody craters and pain as they flake off? Will they definitely flake off all by themselves in the first place? Thank you.
Answer: Graft Healing Can Look Scary — But Time, Care, and Communication Are Key The most important thing right now is to keep strong communication with your surgeon and follow their instructions closely. In situations like this, time is really our best tool — nipple grafts go through different stages of healing and sometimes take several weeks to fully integrate.Graft integration is the process where the graft (the nipple-areola tissue) reconnects with the new blood supply from the chest wall. Early on, the graft survives mostly by absorbing nutrients from the wound bed (this is called plasmatic imbibition), then tiny new blood vessels begin to grow into it (neovascularization).This process can be slow, especially if the graft had areas of poor circulation or pressure. It’s normal for scabs to form, and sometimes the appearance can look worse before it looks better.Even in cases where part of the graft doesn’t survive, the body is very good at healing these areas over time — and there are always options later for tattooing or revision if needed.Stay patient, stay connected to your surgeon, and give your body time to do its work.
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Answer: Graft Healing Can Look Scary — But Time, Care, and Communication Are Key The most important thing right now is to keep strong communication with your surgeon and follow their instructions closely. In situations like this, time is really our best tool — nipple grafts go through different stages of healing and sometimes take several weeks to fully integrate.Graft integration is the process where the graft (the nipple-areola tissue) reconnects with the new blood supply from the chest wall. Early on, the graft survives mostly by absorbing nutrients from the wound bed (this is called plasmatic imbibition), then tiny new blood vessels begin to grow into it (neovascularization).This process can be slow, especially if the graft had areas of poor circulation or pressure. It’s normal for scabs to form, and sometimes the appearance can look worse before it looks better.Even in cases where part of the graft doesn’t survive, the body is very good at healing these areas over time — and there are always options later for tattooing or revision if needed.Stay patient, stay connected to your surgeon, and give your body time to do its work.
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December 18, 2024
Answer: Nipple Graft After Top Surgery If a nipple graft fails after top surgery, the healing process will depend on the extent of the failure. In the early stages (first few days to weeks), it’s often too soon to make a definitive judgment. Grafts may appear problematic initially, but they could still heal over time. In cases of failure, you may experience scarring, "bloody craters," or partial nipple loss. However, pain is typically not severe, and some residual pigmentation may remain.
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December 18, 2024
Answer: Nipple Graft After Top Surgery If a nipple graft fails after top surgery, the healing process will depend on the extent of the failure. In the early stages (first few days to weeks), it’s often too soon to make a definitive judgment. Grafts may appear problematic initially, but they could still heal over time. In cases of failure, you may experience scarring, "bloody craters," or partial nipple loss. However, pain is typically not severe, and some residual pigmentation may remain.
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February 8, 2019
Answer: Niplpe Graft Healing Hi,Thanks for the post and photo. At eleven days, it is too early to determine if the graft is failing or not. I would continue using lubricated dressings like xereform and avoid shearing to the area. Also, areolar grafts tend to look worse before they look better. After a month you will have a clearer picture of how you are healing. Sincerely,Dr. Dadvand
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February 8, 2019
Answer: Niplpe Graft Healing Hi,Thanks for the post and photo. At eleven days, it is too early to determine if the graft is failing or not. I would continue using lubricated dressings like xereform and avoid shearing to the area. Also, areolar grafts tend to look worse before they look better. After a month you will have a clearer picture of how you are healing. Sincerely,Dr. Dadvand
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January 3, 2019
Answer: FTM surgery with double incision and possible failed free nipple grafts HI. First of all, hang in there and it will definitely heal eventually and likely look just fine. But here is my controversial opinion. In my opinion, free nipple grafts never really take. The areola takes just fine, but the thicker bigger nipple really never takes fully. The surgeon did not do anything wrong this is merely the nature of skin grafts. Skin grafts take and heal by a process called imbibition, whereby they develop a blood supply and their life source from the blood vessels on the chest. The thinner the graft the more readily it takes, and very thick grafts NEVER TAKE. Most people use this method for top surgery. I used to use this method, but no longer do because I was frustrated that my patients had to go through what you are going through. SO I developed a technique to make a new tiny nipple using the skin on your chest, and then I just graft the areola around it like a donut. And it works every time.
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January 3, 2019
Answer: FTM surgery with double incision and possible failed free nipple grafts HI. First of all, hang in there and it will definitely heal eventually and likely look just fine. But here is my controversial opinion. In my opinion, free nipple grafts never really take. The areola takes just fine, but the thicker bigger nipple really never takes fully. The surgeon did not do anything wrong this is merely the nature of skin grafts. Skin grafts take and heal by a process called imbibition, whereby they develop a blood supply and their life source from the blood vessels on the chest. The thinner the graft the more readily it takes, and very thick grafts NEVER TAKE. Most people use this method for top surgery. I used to use this method, but no longer do because I was frustrated that my patients had to go through what you are going through. SO I developed a technique to make a new tiny nipple using the skin on your chest, and then I just graft the areola around it like a donut. And it works every time.
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December 17, 2018
Answer: Time and tattoo Thank you for your question. If the grafts continue to have difficulties healing you will likely be left with partial nipple loss and some residual pigment. In this case I recommend that you wait a total of 2 to 3 months for all of the healing to be done. At that point you may desire nipple tattooing where a tattoo artist can place more pigment to the skin and give it the appearance of a nipple. I do not think you will have any pain or unmanageable scarring from this. Make sure you are following up with you surgeon to determine the best management. Best of luck!
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December 17, 2018
Answer: Time and tattoo Thank you for your question. If the grafts continue to have difficulties healing you will likely be left with partial nipple loss and some residual pigment. In this case I recommend that you wait a total of 2 to 3 months for all of the healing to be done. At that point you may desire nipple tattooing where a tattoo artist can place more pigment to the skin and give it the appearance of a nipple. I do not think you will have any pain or unmanageable scarring from this. Make sure you are following up with you surgeon to determine the best management. Best of luck!
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