Do you think my nipples are healing correctly? (Photo)

Question

I am 12 days post op from top surgery. I wore the post op binder 24/7 for 11 days after surgery. Once I had the dressings removed from my nipples they felt great. The next day my nipples feel extremely sensitive. Sort of like road rash would feel when touched by clothing. I no longer feel the random tingling/needle prick pain I was feeling before. I am not sure if the feeling is normal or not. Some of the skin also seems to be peeling off and they are looking pretty gross. I’m worried that they might fall off or the graft is failing.

Rukmini S. Rednam, MD, FACS · Answer

Hi,Thanks for sharing your photos. They are a little blurry but it appears that they are healing fine.  It is not  unusual to have different sensations while you heal, especially as nerves wake up.  At 12 days you have already created new blood supply to the nipples and they will not just fall off unless there is direct trauma to them. It is also very common for the top colored layer of the areola to peel after surgery.   Over a year majority, if not all pigment loss does slowly return.  If after a year it has not, tattooing is an option as well.Best of Luck with your healing!Dr.  Rednam

Krishna Vyas, MD, PhD, MHS · Answer

I specialize in gender-affirming top surgery and "targeted nipple reinnervation" and sensory preservation/restoration.
It is common to experience numbness or altered sensation in the surrounding areas after top surgery, especially around the incisions or areas where the tissue was manipulated. The loss of sensation can extend beyond the directly operated area, such as up to the armpit or above the nipple, even if those areas were not directly operated on. This is due to nerve disruption during surgery, as nerves from the chest and back are affected when the breast tissue is removed or repositioned. While loss of sensation is normal, it usually recovers over time. 
It's also normal for the skin on the graft to peel or flake off during this early healing phase. This is typically part of the process as the new tissue starts to settle. However, if you notice signs like significant drainage, foul odor, or areas that remain open, these could be indicators of complications, and it would be important to contact your surgeon. 
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

Irena Karanetz, MD · Answer

Hello,
Thank you for the question.
Based on the photo provided, everything is healing appropriately.
It can take up to 2-3 months for the nipples to heal fully and for the swelling to decrease, and up to 1 year for the final wound healing to be completed.
I would definitely discuss your questions and concerns with your Plastic Surgeon.
I hope this helps.Best regards, Dr. Karanetz
Dr. Irena KaranetzBreast Fellowship-TrainedBoard Certified Plastic Surgeon

Richard A. Bartlett, MD · Answer

Dear Cierra_milton, Thank you for your question and congratulations on your operation. Based on your photos, it seems you are healing just fine. It is not uncommon to have extreme hypersensitivity following your procedure. I instruct my patients to apply a light layer of bacitracin to the nipples, followed by the placement of a Telfa dressing on either side. This prevents shearing between your skin and clothing. However, I suggest following up with your Board Certified Operating Surgeon for his or her specific recommendations. Best of luck to you!

Tracy Kayan, MD · Answer

From your photos, your nipples look to be healing normally. Given they are put on as full thickness skin grafts, it is common for the outer layer of the skin (the epidermis) to slough off and underneath is a lighter colored skin. Over time, the pigment will most likely return to normal, but this can take months. For now, continue to follow the post operative instructions of your surgeon, and know that the nipple grafts change a lot in appearance over the first 1-2 weeks, and even up to months later. Things to look out for that DO adversely affect nipple graft healing are drainage, odor or open areas. Do contact your surgeon ASAP if you notice any of these.

Babak Dadvand, MD · Answer

Hi,Thanks for the post and photos. It looks like your nipple and areolas are healing fine from the photo. It is not unusual to go through different sensations during the early healing phase. Continue to follow your surgeon's instructions. Your chest looks like it is healing very well.Sincerely,Dr. Dadvand

Jacqueline Anne Luong, MD · Answer

Thanks for the inquiry. In  my experience, the symptoms you are describing are very normal postoperatively. I am assuming you had a free nipple grafts, and if so, your healing also appears appropriate. Oftentimes the grafted nipples will look worse before they look better. Check with your operating surgeon to be sure, though.
Dr. Luong

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