Pus-filled Nipple & Areola? (photo)

PS did large breast reduction & lift on 12/5/12. Areas of areola and nipple look like they are made of pus that PS says are just scabs. Other areola (not in photo) also has very darkened, scabby-looking areas that PS says are also scabs. I had some congestion due to very large reduction so PS says the nipples are struggling but thinks they will make it. Should I be concerned about these pus-filled (looking) areas? There isn't too much drainage from them on my daily dressing changes. Thanks!

Doctor Answers 8

"Pus" Around Areola after Breast Reduction?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Congratulations on having undergone the breast reduction procedure;  Hopefully you will be very pleased with the long-term outcome of the procedure.

Your  picture demonstrates your concerns well;  I think your plastic surgeon has described the situation accurately to you. These types of areas where blood flow is somewhat compromised will likely go on to heal without long-term sequelae or detraction from the outcome of the procedure.

 Continue to follow up with your plastic surgeon and enjoy the benefits after  “large breast reduction” you have achieved.

 Best wishes.

Pus-filled Nipple & Areola?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

In a word YES you need to be concerned. Visit your operative surgeon daily if that will make you comfortable. 

Tissue loss

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It looks like you had some tissue loss and usually this goes on to heal secondarily.  Follow closely with your surgeon.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Decreased Blood Flow to Nipple/ Areola Complex

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The picture provided seems to show a wound with dried

fibrin (yellow stuff) over a wound at the top of the nipple.  This represents area where the blood supply may have been weak.  Local wound care (recommended by your PS) and time will usually solve this issue.

Dr. ES                                                                                                                                                                                                                                                                                                                                                                                                                                                  

Local Wound Care

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You have some minor skin loss from your surgery. The yellow drainage is most likely a combination of plasma and the non-viable tissue liquefying. The wound will most likely heal in over the corse of several weeks with local wound care. This is normally the best course to take in most breast reduction patients- local wound care. Please follow the instructions of your surgeon.
Wound care for most healthy patients can be made simple. Black or brown is often bad in a wound. It indicates necrotic or completely dead tissue. The wound will then often separate from the non-viable tissue and produce a tan or yellow base. With proper wound care this will change to pink or red wound that is often ready for definitive treatment or will close on its own. It can be very common in older breast reduction patients to have a scabbing/ crusting phase in the post operative period.
  Bad things with wounds are excessive accelerating pain, redness around the wound edges that seems to spread, fever, etc. Best,

Gary R Culbertson, MD, FACS

Gary R. Culbertson, MD
Columbia Plastic Surgeon

Wound dehiscence around areola

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You have a partial wound dehiscence of the areola after breast reduction.  From your story it sound like the nipple was congested and may have been struggling with adequate blood supply.  The best thing is to be patient and dress the wound with Silvadene provided you are not allergic.  Silvadene will protect the wound from infection, prevent dessication of the wound and promote epitheliazation of the surrounding skin edges.  The wound should heal on its own but there is a chance that after everything is healed and the scar matured you may need a scar revision to make the areola look more tidy.

Benjamin Chu, MD, FACS
Honolulu Plastic Surgeon
4.8 out of 5 stars 106 reviews

Breast Reduction Healing Problems

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

         The area at the top of your areola is a combination of devitalized tissue and healthy granulation tissue.  It will likely heal with minimal problems with the final scar.  The exudate is not pus, it is just granulation tissue.

Delayed wound healing after breast reduction is uncommon

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You appear to have some 'delayed wound healing' along the nipple-areolar complex wound closure - this is not the typical appearance of a breast post reduction/lift. I would recommend visiting your plastic surgeon frequently for wound checks. In most cases, this situation heals with an acceptable scar that can be revised at a later time.

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.