Is it better lo leave the scab alone (and dry) or try to make it fall? (photo)

Question

I have a thick scab over my right nipple due to necrosis. I had bl with implant done in Colombia on Oct 29, 2013, my right nipple turned black (necrotic) and now 1 month after the surgery I still have a thick scab over. Is it better lo leave the scar alone (and dry) or try to make it fall? I read on Google that a good way to loosen it up was to apply a water base paste of baking soda and it did soften the scab but the sides now look gooey and the skin underneath is very red/pink. I want to speed healing, I am desperate!!!

Dana Goldberg, MD · Answer

Small scabs are definitely better off when left alone. Pulling off a scab can worsen the final scar in many cases since the environment under the scab stays sterile, moist for growing cells, and protected from the outside world.For larger scabs like yours, it is sometimes better to have a physician remove the scab surgically and treat the wound with dressings to speed up healing. It's not skin you see under a scab that large but tissue called "granulation tissue" that will eventually become covered with skin that will grow in from the edges. Areas where there are scabs as large as yours usually heal with thin skin and worse looking scars than the incisions around it. This can be revised in the future once the tissues soften up (6-12 months after healing).  I advise you to make an appointment with a board certified plastic surgeon in your area for evaluation so you can sure you are doing everything you can to optimize your outcome.

Asif Pirani, MD, FRCS(C) · Answer

You need to see a local PS in your area.  You risk exposing the implant if you remove the scab.  Please see a PS ASAP.

Ryan Neinstein, MD, FRCSC · Answer

I agree you should see a local surgeon, I sometimes remove these as they are basically hanging on and dont do what they are supposed to do and act like a "medical dressing that is sterile"

Shim Ching, MD · Answer

You really need to see a surgeon to help manage your complication.  Generally, we would allow the dark area to fall off on it's own, but you need to seek professional advice immediately.

Robert Brueck, MD · Answer

I would see a plastic surgeon.You want to prevent infection which could cause you to lose your implant.This is one of the many problems that can arise from going overseas to get plastic surgery.If a complication arises you have a long way to go to get help.think twice about it in the future.

Curtis Wong, MD · Answer

need to be managed by a local surgeon who can help you with wound care and other issues should they develop.  If your implants are over the muscle, you could be facing exposure of your implant when that scab falls off.  If you can contact your surgeon via the Internet and are comfortable sharing your photos on-line, your surgeon could provide you with wound care instructions.

Darryl J. Blinski, MD · Answer

It is the option for your surgeon to decide. In my practice I tend to remove necrotic tissue as it demarcates.

Barry Press, MD · Answer

This is full thickness tissue loss. I assume you cannot return to Columbia for followup so you should see a board certified plastic surgeon ASAP for supervised wound care. You are at high risk for an infection around the implant which will necessitate its removal.

Is it better lo leave the scab alone (and dry) or try to make it fall? (photo)

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