Does this wound look like its healing? (photos)

Question

Is the white around the edges of the wound mean its healing or something else? How long does it take to heal? I am 4 wks post op BL/BA. I had an open area when my stitches were taken out, which has gotten worse with spitting stitches. I am following up with my surgeon weekly.

Richard H. Tholen, MD, FACS · Answer

This is not common, but neither is it so rare that plastic surgeons have difficulty treating this. We have all seen varying degrees of this in patients (some from other surgeons, some in our own), and your surgeon is caring for this properly, at least as much as can be told from your photo.The white around the edge of your healing wound is dermal collagen; fibrin is the surface layer that can be scraped off to reveal pink, bleeding (healthy) granulation tissue. Epithelium will need to grow in from the ides of your wound, and although there will be more final scarring than if your wound edges had stayed together, your new final scar will be surprisingly smaller than the present wound would suggest. Local anesthesia scar revision is always possible, but many patients heal wounds just like yours so well that after they soften and fade they decide that scar revision is unnecessary. Yup, it CAN end up that much better than you are worried about right now.Of course, avoidance of further wound separation, disruption, or development of infection is critical, so follow your surgeon's advice and frequent recheck schedule. Keep activities low that might mechanically disrupt this weaker area (like visiting establishments that serve liquor), and take it easy as thing heal. This always takes longer than you want, but less than it seems it might by looking at it right now. Several weeks would be average.Mechanical removal of the fibrin debris on the surface of the wound (by your surgeon each visit without anesthesia or "cutting") will assist the healing process. Your keeping the wound clean and moist without infection will further enhance the healing rate. Letting this dry out, or failing to wash the wound "because it bleeds" is NOT good. Remember that healthy tissue bleeds, so a bit of surface oozing only releases platelet-derived healing factors from your blood to the wound surface--all good. Infection and dryness slow or reverse healing--NOT good.This may have been an example of Vicryl or Dexon braided absorbable sutures that became contaminated by skin bacteria and formed tiny stitch abscesses, leading to wound breakdown and stitches "spitting," as you have described. This is why I prefer monofilament sutures for skin closure. Not that using monofilament sutures "prevents" this from happening; but it DOES reduce the risk. Wound breakdown can happen even with monofilament sutures if the wound closure is too tight or the implants chosen too big, but may be more common with the braided absorbable sutures that can harbor otherwise "normal" skin bacteria within the tiny suture braided construction interstices, leading to "spitting" stitches.I rarely see this problem since I have switched to non-braided absorbable sutures, and now see wound breakdowns such as yours most commonly in patients who smoke or are exposed to second-hand smoke, causing nicotine vasoconstriction and ischemic healing problems in the wound edges. I don't know if either, both, or neither of these issues apply for your specific case, but it is useful to mention for other readers.Hang in there and see your surgeon frequently. This will ultimately be just fine! Best wishes! Dr. Tholen

Jeffrey J. Roth, MD, FACS · Answer

Thank you for the photo.  It appears that the wound has opened.  This can be caused by a few things. Usually it is tension on the wound.  Sometimes a suture placed in the wound under the skin will spit out.  This may cause the wound to then open a little.  We have all seen this with this operation as by definition the incisions are on tension. It does not look like pus/infection, (although seeing it in person would give a better analysis).  What you are most likely seeing is granulation tissue, (pink/red). This is highly vascularized tissue.  It may bleed when touched.  The epithelium will then march across it.  Please continue to see your board certified plastic surgeon and follow his/her advice.

Martin Jugenburg, MD · Answer

Unfortunately, sometimes patients develop these superficial openings.  This will heal given enough time.  Follow your surgeon's wound care instructions.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Thanks for the picture. Unfortunately wound breakdown can happen with the breast augmentation and lift.  The wounds look like they're healing satisfactory to this point. Continue to follow up with plastic surgeon.

Alejandro Nogueira, MD · Answer

This wound did not open due to infection, bad stitching technique, wrong deep glandular technique, etc, it is open due to mechanical over tension. Its depth is fleshy, granulative and healthy, and will begin to close when the tension is reduced after swelling.This problem, not serious it seems, happens in uplifts with too wide implants, or when the patient is not absolutely inmobile at home the first 2 weeks.Regards

Jeffrey Umansky, MD · Answer

Thanks for the question and photo. Sorry to see you are having a tough recovery. Wounds like this are common after a augmentation/mastopexy and usually heal with time. The white tissue is a normal response to healing called "fibrinous exudate" and is not a sign of infection. Continue your follow ups with your surgeon and you should do fine. Good luck!

Ronald Levine, MD · Answer

It would be difficult to tell you how you're progressing without seeing photos of how you looked in the days/weeks before this photo. If you're seeing your surgeon weekly and following their care instructions, you are doing the right things.

Heather J. Furnas, MD · Answer

Sorry to hear of your trouble. Open wounds can happen in your type of operation. As long as the implant itself is covered and not exposed, your wound should slowly heal. Follow up frequently with your surgeon and follow all instructions.  Good luck in recovery.

Jourdan Gottlieb, MD · Answer

With a single photo at one point in time it is not really possible to comment on whether this is healing or not. Overwhelming chances are that healing is occurring. It is helpful to have any exposed sutures removed--they are not needed by 4 weeks. Local wound care should allow this to healing within a couple more weeks, though it may be a year until the redness is all gone.Best wishes.

Does this wound look like its healing? (photos)

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