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!
Pus-filled Nipple & Areola? (photo)
Doctor Answers 8
"Pus" Around Areola after Breast Reduction?
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.
Pus-filled Nipple & Areola?
In a word YES you need to be concerned. Visit your operative surgeon daily if that will make you comfortable.
It looks like you had some tissue loss and usually this goes on to heal secondarily. Follow closely with your surgeon.
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Decreased Blood Flow to Nipple/ Areola Complex
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.
Local Wound Care
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
Wound dehiscence around areola
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.
Breast Reduction Healing Problems
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
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.