Breast augmentation breakdown of scabs around my left nipple still after 12 weeks? Non-smoker (Photo)

Picture shows what my nipple looks like now, some of my nipple has now been eroded. It's been 12 weeks since it originally broke down and I've been going back to the clinic for regular dressings every week where nurse uses charcoal/silver dressings, but they keep over-granulating stopping the healing. Going to try airing them out by taking off the dressings every evening. Will this help? Are there any other things I can try and do? I'm taking vitamin C and trying to eat more fruit and veg too.

Doctor Answers 6

Scabs around your nipple.

Best Scar Management is important to minimize or completely hide from view, the telltale signs of your surgery—namely, scars. Both you and your surgeon want you to have the most minimal scarring possible. There are many possible causes for scars that are enlarged or not healing well. Unsightly scars are most commonly due to genetics, underlying medical conditions, or improper scar/wound care. The last part is very important and patients can make a noticeable difference in their scars’ appearance by following best scar management practices. Here are some simple tips.

Scar Management tips:

  1. Minimize tension on the scar. Steri-Strips and/or surgical tape are often placed in non-hair bearing areas at the time of surgery to minimize tension and keep pressure over the scar.  This minimizes the  stress that  can pull the scar apart (dehiscence) creating a wound and  delaying healing time, and can make the scar wider, or more “ropy”. In the first few weeks after surgery, I recommend the use of Embrace Scar Therapy which is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar.
  2. Keep your incision site/scar clean to prevent infection. Follow your surgeon’s wound care instructions to the letter with out modification. Never apply different products then recommended without first discussing them with your surgeon. This is especially important during the first few weeks. If there are any signs of infection, contact your surgeon’s office right away and/or see your doctor or his nurse immediately. Typical signs of infection may include redness outside the immediate incision site, asymmetric swelling, and drainage, of pus, fever, chills, and “feeling sick”.
  3. Protect your scars from the sun. Staying out of the sun is the best advice. Minimal exposure to sunlight is prevents hyperpigmentation (permanently turning brown) and other problems that can make the scar more noticeable. Sunscreen, at least 30 SPF and an overlying make camouflage make up additionally protects the scar from the suns harmful rays. This advice is especially important the first year following your surgery.
  4. Use specific scar maturation products recommended by your surgeon. Patients seem to have their own opinions on this touting everything from Pure Vit E, Coco butter, to Aloe Vera, etc but most have minimal benefit other than keeping the scar hydrated. Although hydration is important there are better, scientifically studied products with greater efficacy. Most of the scientific articles written about this subject indicate that topical silicone gel or silicone sheets work the best. The best product available in my opinion is the Embrace Scar Therapy System by Neodyne BioSciences, Inc. available in many surgeons’ offices. Essentially this is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar. For areas that are not applicable for this product (e.g. smaller areas or on the face), I prefer BioCorneum or Kelo-Cote products There are a lot of products to choose from, but silicone should be one of the key ingredients. Although Mederma, an onion extract derivative active ingredient rather than mainly silicone based may help, primarily silicone based products are better and many also contain other ingredients that may be synergistic (hydrocortisone or other steroid, Vitamin E, Sunscreen, etc).. If the reader has problems obtaining these they can call my office. Patient compliance is also critical – use often and according to directions or it will not work optimally. NEVER apply products without first discussing them with your surgeon.
  5. Monitor to make sure your scar is progressing optimally. Keep your scheduled follow-up appointments with your surgeon to verify that your scars are maturing as expected.  Occasionally if indicated you may need a topical steroid preparation or even a series of  injections (5-FU and/or Steroids) or laser treatments  to treat or  prevent scar hypertrophy or keloid formation (red raised scars), or other topical medicines to treat post inflammatory hyperpigmentation (brown scars) with prescription creams and possible laser treatments.

Poor Nipple Healing After Breast Augmentation

Thank you very much for your question and photograph. I’m sorry to hear that you have had such a rough recovery from your breast augmentation. I would advise you to schedule an appointment with your operating surgeon, instead of the nurse. He/she can further assess your situation and recommend the necessary steps to ensure your nipple properly heals.

Paul Vitenas, Jr., MD
Houston Plastic Surgeon
4.8 out of 5 stars 104 reviews

Breast augmentation breakdown of scabs around my left nipple still after 12 weeks? Non-smoker

I do think that nutrition is very important to healing.  The reaction of stitches can sometimes compromise wound healing as well.

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Areolar Incisions Have Broken

Hello, and thank you for your question. I am sorry to hear that you have had such trouble for 12 weeks now with your incision and the healing of the scar.

Typically the peri-areolar) incision heals very well. This incision option is ideal for saline implant placement.  Saline implants require a smaller incision because they are not filled until they are inside the body.

Also, with the nurse simply re-dressing the incision it might be a valuable appointment to make sure that you see the surgeon directly for a follow-up to have the incision site examined for proper healing. Best of luck to you. I hope things improve in the near future.


HERE ARE SOME BASIC HEALING TIPS AFTER BREAST SURGERY, AUGMENTATION, LIFTS:

1.    pain is variable

2.    it takes 2-3 months for implants to settle and muscles to relax

3.    celebrex, motrin, and muscle relaxers can help

4.    massage and stretching may help

5.    everyone heals differently

6.    4-7 days off from work is common


Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 96 reviews

Overgranulations

If the overgranulations are stopping the healing I would first try a mild steroid cream such as Terracotril. If this doesn't work, and there are large overgranulations, treatment with silver nitrate sticks are often effective. You should first discuss any treatments with your surgeon.

Anthony Barabas, MBBS
Cambridge Plastic Surgeon
5.0 out of 5 stars 8 reviews

Breakdown.

I'm sorry to hear your wound is giving you so much trouble. I think you should go see your plastic surgeon again and consider taking additional antibiotics by mouth. There are small glands around the areola which may have cause the suture material to be come exposed to bacteria. Consider your nutritional state and ask your surgeon to give you a list of supplements you can take to heal faster. Some of these might include vitamin C, Omega 3 oils, zinc and a few others. I'm glad to hear that you don't smoke, but also be sure you are avoiding second hand smoke which could also be detrimental to good wound healing. You should keep a good relationship with your plastic surgeon as it looks like you will need revision. Best, Dr. ALDO

Aldo Guerra, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 190 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.