I have developed an open sore under my left breast that continues to open at the scar line? (Photo)

Question

Breast Lift 3.5 weeks ago. I went to my PS who I trust and is a board certified PS. He said it would heal & to apply dry gauze daily. So I am really asking for reassurance that this will happen. He said it may get worse before it gets better (which is what is happening now) It seems to be separating more at the scar line 2 - It's tough to wear a supportive bra with the sore. Is it ok at this stage to not be wearing a bra as the instructions were to wear one full time for the first 5 weeks.

Raffy Karamanoukian, MD, FACS · Answer

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars. 
 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Vishnu Rumalla, MD · Answer

Thanks for your inquiry,  your surgeon is right that sometimes these wounds get worse before they get better.  My only suggestion is ask your surgeon about adding muciporin ointment so it won't stick or a silver dressing.  This may slightly speed up the process and good luck.

Dallas Buchanan, MD · Answer

Thank you for your picture and questions. Sounds like your surgeon is spot on. This is an area where the blood supply to the skin was compromised and now you have developed an open wound. This may take some time to develop fully so it may appear worse at first. However, with good local wound care, it will go on to heal with time and will leave a widened scar in this area. This is not an uncommon occurrence. I would disagree slightly on the wound care though. It has been shown that wounds heal faster in a moist wound healing environment, so I would encourage you to wash the area with soap and water daily to keep it clean and then apply antibiotic ointment and a bandage. Stay in touch with your PS. Hope this helps!

Deborah Sillins, MD · Answer

It will take time for the opening to close. I would discuss with you Plastic Surgeon to place a moist gauze with saline to help with wound healind

Aldo Guerra, MD · Answer

Wound separation is very common with breast lift. Even at the most prestigious medical centers in the US, up to 1/3 of patients developed this complication in studies which have been published. My point is that this wound complication can be handled from experience with previous patients. You need to see your plastic surgeon more now that this is getting bigger for a formal evaluation. You should ask your surgeon for a list of supplements to take to improve your wound healing, for very specific wound care instructions, bra wearing instructions, and whether your lesion needs to be re-sutured now or in the near future. Only your plastic surgeon can make this call. Best wishes, Dr. ALDO

Anne Taylor, MD · Answer

Hi there-- this is the part of the incision that has the most tension on the closure so is the most common place to have delayed wound healing.... IT WILL BE FINE! Just take care of it and over the next few weeks it will heal up-- and don't you feel better through your back and neck after your breast reduction?!! YEA!

Marcos Cuevas Soto, MD · Answer

Hello thanks for your question, when we perform breast lift with the inverted T technique, sometimes a break occurs in the union of these three points, this usually closes in 3 weeks with daily cures, you can use arnica powder that helps a lot In those cases, the other option, which is what I do in my cases is to close the wound again, with local anesthesia in the office and the constant use of brasiere, it is important to keep in touch with your doctor.

Angeline Lim, MD · Answer

After a breast reduction, it is not unusual for certain spots to take longer to heal - these are often referred to as the "t-junctions" along the vertical scar at the top near the areola and at the bottom near the base of the breast.  Because of the nature of these spots - you have three different sections of skin that need to seal together - some patients can develop small wounds that will eventually heal with care and attention.So as your plastic surgeon advised, your sore may get a little bigger and look a little worse before it gets better - very typical for these types of wounds.  I often tell my patients to keep their wounds slightly moist (either with a saline wet-to-dry dressing or antibiotic ointment), pad over with some gauze to prevent irritation from the bra, and wear some good support to help take tension off the healing skin.  Be sure to check in with your own surgeon about his preferences regarding the bra.Hope this helps reassure you, and best of luck during your healing and recovery - Dr. Lim

David A. Sieber, MD, FACS · Answer

Thanks for the great question! You have what is called T-point break down. This is common in breast lifts and can happen in 15-20% of patients. The reason the wound developed is because this T junction of the skin has poor blood supply as it is the furthest distance blood has to travel to deliver oxygen and nutrients. It's not fun when this happens, but the good news is that these always heal up with time. It may take a number of weeks to heal, but they almost always do. Be patient and continue to work with your PS as they will be able to instruct you on appropriate wound care. ~Dr. Sieber

Steven Turkeltaub, MD · Answer

An area like this will heal with time. Generally, a moist type dressing will be more beneficial for wound healing rather than a dry gauze which can result in dessication (dryness) which then leads to more tissue loss and slower healing. An example would be to apply silvadene cream to the area twice a day (though there are also other choices as well).Follow up closely with your plastic surgeon.Steven Turkeltaub, MD

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