Nipple Necrosis After Breast Lift

But you must first resolve any infection that is present, remove any obviously-dead tissue as it is just a warm, wet, area of dead culture media for bacteria to thrive in (this requires surgical debridement), try to minimize any further tissue loss (If you are smoking, you must STOP, including any kind of nicotine gum, spray, patch, or electronic cigarette, as well as any exposure to second-hand smoke). This is critical, and perhaps is one explanation as to why you may have developed this problem to start with.

This does, however, occur in non-smokers, but it is uncommon. and it is further aggravated by the fact that you had implants in a pocket that deprived some of the overlying tissue of its previous blood supply. Add an allergic response, or traction blisters from steri strips (I no longer use them and haven't for years because of this very issue), and ischemic tissues, and you have a perfect culture broth for bacteria to take hold and do more damage, which further decreases blood flow and increases tissue loss.

This has happened to all of us who have done this kind of surgery for years, and I would respectfully submit that your surgeon is as devastated by this as you are. Your best response as a patient will be to take a non-blaming, thankful attitude for his/her help, reassuring that you won't sue or say bad things about him/her, and allow your surgeon to proceed with getting you better. This unfortunate situation truly can happen despite doing everything surgically right; and it's not your fault going forward unless you continue to smoke (if that is applicable) or if you fail to follow up with your doctor or follow good advice.

You will need dressing changes, debridement as necessary, healing and scar maturation over many months, and eventual rebuilding of a new nipple areola complex. This can definitely be done, and can yield VERY good results, as virtually all ABPS- certified plastic surgeons with reconstructive experience have reconstructed nipple/areola complexes after mastectomy. It's a bit of a journey now, but hang in there and all will turn out OK! Good luck! Dr. Tholen

Kim, obviously you have a serious problem evolving. Hopefully, you are in the hands of a board certified plastic surgeon who should know how to treat this well-recognized complication (although rare) of a mastopexy. At this time, it is hard to tell the fate of your nipple but this will be obvious over the next week or so.

I strongly recommend that you urgently seek the advice and care of a competent board certified plastic surgeon for the issues that you are having. 

If the nipple is truly necrosed then  there is no "bouncing back".It will have to be debrided  and allowing time for spontaneous healing of the inflamed tissues followed by nipple areolar restoration.

Truly sorry to hear of your condition.

The operation you had, breast implant removal combined with breast lifting is notoriously prone to healing complications and especially so if done in active or second hand /passive smokers. Healing is dictated by the amount of blood supply coursing through the breast skin. Breast augmentation and especially over the muscle breast augmentation removes much of the blood supply which goes between the pectoralis major muscle and the overlying breast. A breast lift removes a variable segment of the sagging breast skin and its blood supply contribution to the areola. If done in smokers whose blood supply is in spasm and poor already you have all the makings of a perfect storm with a variable degree of blood supply loss to the areola and incision.

At this point you infection needs to be controlled with proper antibiotic therapy. The wounds need to be cleaned and allowed to heal. In a few months when you are healed and the tissues have softened (and IF you were a smoker - you are off nicotine), a revision and reconstructive procedure with creation of a new areola - nipple complex may be done.

Good Luck.

Peter A Aldea, MD
Memphis, Tennessee

I am sorry that you are going through this. You will be fine in long run. It will take time and effort to get there. The loss of the nipple areola is a known  risk of  implant removal and mastopexy. You will have depressed area of the nipple for  while and it may take 2-3 months to heal. Make sure your surgeon is board certified and I promise you he or she  is devastated with what you are going through. 

It is important that your surgeon is a board certified plastic surgeon and closely involved with your problem.  Tissues may be saved if treated properly and without delay.  Infection control is important as well as proper wound management after tissue necrosis.  Donald R Nunn MD Plastic Surgeon.

It is unfortunate that you are such difficulties after surgery, but don't despair, yet.  You don't say what you consider a fever.  A normal body temperature goes up and down during the day.  After a large surgery it may go up to 100 or 100.5.  This alone does not mean there is an infection.  Two days after surgery while on oral antibiotics would not necessarily alarm me.  The wound may need to be cultured to identify an infection and what antibiotics it will respond to.  At six days you cannot know how deep the necrosis (tissue death) is.  All you can do is wait.  The area needs to be kept clean and you should see your surgeon often in case there is dead tissue to be excised. This will reduce the chances of ongoing infection and help with the healing process.  Hard as it seems, try to keep your spirits up.  Stay strong if you can.  Complications occur and if you're the one who gets one then for you it's 100%.  It will be a week or two before you know how bad this situation really is and a few months before  the healing is done and your surgeon can assess what needs to be done.  It's not always as bad as it looks.  Just take it one day at a time.  Good luck. 

If you are not with a board certified plastic surgeon, I recommend you change to one, 

or, at the least, get another opinion.  This operation can be problematic.  There must

be enough blood supply for the nipple and areola to survive.  The surgeon must cut around it

to be able to move it up.  Then he/she is putting an implant under it which creates more pressure.

With necrosis there is no turning back.  You will have to go through this prolonged healing process.

Then there will be options to reconstruct the nipple areolar complex, which can be very effective.

Keep the faith.