What is going on after my breast reduction? It had a little infection which they cleaned out. (Photos)

Question

I'm in extreme pain they say I should be feeling better but I'm not what could be wrong they are giving me no answers could they have hit a nerve

Daniel Barrett, MD · Answer

Dear nikelynn23,
this type of wound is not uncommon after breast reduction. It is usually caused by poor blood flow. I would suggest you to follow your surgeon's instructions and keep your wound clean and covered. It can take few weeks or months for wound to fully heal. 
Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Gary L. Ross, MBChB, FRCS · Answer

Unfortunately you have developed a large area of skin necrosis and the wound is now granulating. With regular dressings this should heal and you will need advice re the dressing and subsequent scar management. This will take a number of months and best that your PS sees you regularly through this time.

Daniel Zeichner, MD · Answer

Hi and welcome to our forum!
Breast reduction requires extensive undermining of the tissues, partially stripping away the blood supply. Although the incisions are designed to minimize this phenomenon, partial skin loss is not uncommon. The underlying tissues are granulating ( developing a beefy red complex of blood vessels which fight infection) as there appears to be adequate soft tissue blood supply. Once the granulations mature, the wounds will begin to shrink over 6-12 weeks, sealing the wound from the periphery inward to the center. In most instances, these wounds will completely seal. On occasion, a skin graft may be required to completely seal the wound. A regimen of intensive wound care will be required. Close followup with your plastic surgeon is necessary.
Allow the scars to mature over 12 months. Many patients do not require scar revision!
Best wishes!

Lavinia K. Chong, MD · Answer

Thanks for sharing your pics.  Wound dehiscence  or separation was probably caused by the wound infection.  The deep pink tissue is granulation tissue, a conglomerate of blood vessels, which serves as the "carpet pad", over which the skin will eventually resurface, making the margins join.  Granulation tissue has a "beefy" appearance (from the blood vessels) as well as nerves, which makes dressing changes uncomfortable.  As the wound heals by secondary intention (contracting & resurfacing), your pain will decrease and hopefully. Do work with your PS to agree on a suitable wound care regimen, which allows the granulation tissue to be well vascularized and slightly moist.

Mohamad H. Bazzi, MD · Answer

Wound dehiscence, or breakdown, is a potential complication with any surgery.  It's clearly not what any surgeon wants for their patient but is often not something that can be predicted.  If you had another procedure you may have some temporary increase in discomfort but it should be relatively tolerable.  Be sure to keep close follow up with your surgeon.  Wound healing can be lengthy and requires close follow up and patience.
Good luck.

Sanjay Mukerji, MD · Answer

You have part of the skin flaps not survive after the reduction. Fortunately, the underlying tissue seems to have good circulation and it is producing granulation tissue. Usually there is not much pain, but that varies from patient to patient. Surprisingly, the end result is usually not bad after it heals, because the skin grows in from the edges and closes up the wound. The resulting scar is wider but improves over time. I would advise you to continue to follow up with your plastic surgeon on a regular basis and continue with wound care.
Sanjay Mukerji, MD 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Kelly Killeen, MD, FACS · Answer

It is common to have an increase in pain for a bit after any procedure.  If the pain is as extreme as it sounds, I would recommend in person follow-up to make sure there is not something else going on with your healing. Good luck!

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