Nipple: Infection/Necrosis, Fat Necrosis, or Normal? 4 Weeks Post BR (photo)

           Yes, the viability of the nipple areola complex has been compromised, but, judging from the pictures, your nipple has been spared and there is intermingled viable tissue.  What this means for recovery is that the final outcome will probably be similar to your other breast.  Once the darker tissue sloughs, the underlying tissue will likely be fine.  It will take longer to heal but will be fine.   What you likely smell is not pus, and the discharge is the likely result of healing not infection.

I am sorry that you are having such a difficult complication.  It is not normal but of course it is a risk.  See your surgeon frequently to work through this problem as smoothly as possible.  You will likely have scar revision surgery in your future.

Sorry to say you have nipple/areolar necrosis that needs debridement and intensive wound care. Best to discuss with your surgeon or find a second surgeon to care for this issue. 

I'm sorry to hear/see the complication you have experienced after breast reduction surgery.  Your being "scared” is quite understandable.

 Although I cannot give you precise medical advice online, some general thoughts may be helpful to you. As you know, the problems you are experiencing are likely related to decreased blood flow to the tissues involved.

At this point, your best recourse ( besides close follow up with your plastic surgeon) may be patience  and time. It is likely that you will find that the areas of "unhealthy” tissue will gradually be evacuated from your body. In other words, areas of fat necrosis may gradually liquefy and drain.  Areas of dark skin/tissue  will also gradually lift and you may find the existence of healthy tissue underneath.

 This process may take several weeks to occur. In the meantime, it will important for you to follow up closely with your plastic surgeon, who is in the best position to rule out secondary infection...

 Although it is not possible to predict the final outcome, you may be surprised  at how well you will do in the long term.

 Best wishes and Merry Christmas!