One of my Nipples Has Turned Completely Black After Breast Reduction, What Should I Do? (Photos)

I underwent surgery 15 days ago. I went from a 36H to a 36D after a week or so my right nipple started to bleeding and turned black. My plastic surgeon says it´s only partial necrosis and the best way to go is by solely applying antibiotic ointment. I really want to trust him on that but I´m so worried about losing my nipple (if it´s not too late already). Should I get a second opinion?

Doctor Answers 2

One of my Nipples Has Turned Completely Black After Breast Reduction, What Should I Do?

Your surgeon is the only one who examined you closely and I would like to believe him but by the looks of the left and central photograph you APPEAR to have a near complete loss of the areola / nipple complex with impending separation of the top half of the vertical incision. This is a known complication of reducing very large breasts especially with a very long pre-surgery distance between the nipples and the sternal notch (the bony depression at the base of the neck). This becomes more likely if done in smokers (active or passive or women with diabetes or certain immune diseases).

At this point, unless infection supervenes, most surgeons would treat you with an antimicrobial ointment (such as Silvandene or others) and wait for the living tissue to separate itself from the dead tissue. Once that is done you will require one or more small procedure to remove the dead flesh and the wounds would then heal by themselves. A skin graft may be needed to recreate the nipple complex.

Your surgeon may be trying to shield you from these facts. I would approach the situation calmly and try and find out how you can work together to solve this problem. It is completely solvable so do NOT despair.

Good Luck.

Peter A Aldea, MD

Memphis Plastic Surgeon
4.9 out of 5 stars 108 reviews

Nipple-areola necrosis?

Assuming you've selected a well experienced board certified plastic surgeon to do your breast reduction procedure I would stay the course with him/her. There is no doubt that there is compromise of the blood flow to the nipple/ areola- whether it is “partial” or complete, only time will tell.

I would continue close follow-up with your surgeon and would recommend topical antibiotic treatment and otherwise conservative debridement only if/when necessary. This will allow for preservation of as much breast tissue as possible making future reconstruction easier.

Again, make sure your surgeon is a  board certified plastic surgeon-  a “2nd opinion" is unnecessary. What you are experiencing is undoubtedly stressful to you and your surgeon; ask him/her not to sugarcoat his or her opinions.

You will undoubtedly require further treatment and/or surgery later outcome may still be very nice.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

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