Nipple Sloughed Off From Necrosis Following Mastopexy.....normal? (photo) [graphic]

Question

I had mini mastopexy on Dec. 14th. I can clearly see the left nipple has necrosed and sloughed off but my doctor keeps reassuring that this is normal and everything will heal perfectly. I am 25, non-smoker, and healthy. Why did this happen? My left breast is still painful compared to the right one. Surgeon said he had to dissect the left side more which is why it was more “beat up”. Will my nipple eventually heal and look normal or do I have more surgeries in my future?

Vishnu Rumalla, MD · Answer

Thanks for your question. Nipple necrosis after a mastopexy is not common but unfortunately can happen. Your second question if the nipple will be "normal" is more difficult one to answer. In my opinion, your left nipple will always be different from the right and have more scar tissue. You may need revision surgery depending on your aesthetic desires to create symmetry. Good luck.

Don W. Griffin, MD · Answer

From your picture, it appears that your nipple has survived, but that part of it has been compromised. Once this area heals, you may need a scar revision to improve the appearance. Continue close follow-up with your surgeon.

Steve Laverson, MD, FACS · Answer

Keep the areola clean, and let it heal. Looks like you had augmentation in addition to breast lift, which can compromise circulation to the areola. Don't worry, the areola heals well and can later be revised if necessary, either surgically, with tattoo, or both. As long as the nipple doesn't turn black and fall off, you will likely have a satisfactory outcome.

Vladimir Milovic, MD, FRACS · Answer

Thank you for your photos. You seem to be recovering well after a partial necrosis of your nipple. The key is to continue close follow-up with your surgeon. It is difficult to predict appearance of the nipple areolar complex following such an event. Most likely you will require minor scar revision surgery, best of luck.

Steven Turkeltaub, MD · Answer

For some reason, there was vascular compromise of the left nipple-areola complex resulting in an inadequate inflow of blood. The result was loss of tissue and scarring. This is permanent and you won't have any nipple short of reconstruction. 

	By the way, your procedure was a periareolar mastopexy, not a mini mastopexy.

Darryl J. Blinski, MD · Answer

Sorry for your issues. But the photos indicate an early healing occurring. Best to allow full healing over the next 3 months than determine if further surgery is needed.

Tom J. Pousti, MD · Answer

Thank you for the question and pictures.

	Unfortunately, what you are experiencing does occur on occasion after any type of surgery that involves moving the nipple/areola complex. As you probably know,  this is related to compromise of arterial inflow and/or venous outflow to the areola.

	Obviously, no one can predict exactly what will happen in the future but based on your picture it seems that the tissue loss is &ldquo;partial thickness&rdquo; ( the pink area of the areola  suggests that full thickness necrosis has not occurred).  Time will tell what the final appearance of the areola will be and whether you will benefit from scar revision surgery.

	I would suggest that you continue close follow-up with your plastic surgeon.

	Best wishes.

Nipple Sloughed Off From Necrosis Following Mastopexy.....normal? (photo) [graphic]

Answers (7)