Nipple necrosis after breast reduction... now what? How long does it take to heal? (photo)

Question

My surgeon didn’t refer to it by name but I have now researched enough to realize what it is. I had a couple of questions... 1) How long does it take to heal? 2) Could it have been avoided by using implants for symmetry rather than a breast reduction on one breast? Could it have been avoided in general with a different surgeon? I hadn’t smoked or drank in more than 2 weeks... 3) Can I get in pools this summer at all or beaches? 4) Can I drink at all?

Kenneth Hughes, MD · Answer

Yes, the viability of the nipple areola complex has been compromised, but, judging from the pictures, your nipple has been spared and there is intermingled viable tissue.  What this means for recovery is that the final outcome will probably be similar to your other breast.  Once the darker tissue sloughs, the underlying tissue will likely be fine though it will take longer to heal.   I would discuss swimming with your PS.  Tanning and sun exposure in general will cause the scars to hyperpigment. Drinking in moderation after completion of medications should not be a problem.Kenneth Hughes, MD, ABPS Board Certified Plastic SurgeonLos Angeles, CA

Ajay Mahajan, MD, FRCS (Plast) · Answer

It is very unfortunate that you have developed necrosis of the nipple, however there does appear to be healthy tissue is some areas. You will need to wait patiently till tissues demarcate and the true extent of the necrosis revealed. Time to heal will depend on the degree of necrosis. You will probably get away without the need for debridement and skin graft, but time will tell. Necrosis of the nipple is mainly technique dependent and variation in anatomy can sometimes be an issue, but smoking is a major contributory factor. I do not tend to operate on patients for breast reduction for atleast 6-8 weeks after they have stopped smoking and prefer to wait for 12 weeks till the tissues have had a chance to recover from the effects of smoking. Drinking alcohol does not affect wound healing, on the contrary, in moderation it may help you relax and relieve the stress caused by this unfortunate turn of events!!

Daniel Barrett, MD · Answer

Dear omqa,
it is hard to tell for sure, but based on your photo, it looks like your problem is superficial and it should heal with time. I suggest you to avoid nicotine and follow your surgeon's instructions. It can take few weeks or months for wound to fully heal. 
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Martin Jugenburg, MD · Answer

You appear to have some superficial sloughing, not a full nipple necrosis.  This is something that should heal with proper wound care.  It will take longer to heal but should heal well.  You should have no problems with going to a pool or drinking.Make sure to follow up with your surgeon and follow proper care to optimize healing.

Matthew A. DelMauro, MD, FACS · Answer

Hello, and thank you for your question. (Keep in mind that an in-person consultation is necessary for the best advice.) I'm sorry to hear about the trouble you have had after surgery. Wound healing complications are not uncommon after breast reduction surgery. Local wound care is the treatment. How long it will take to heal varies. You shouldn't swim until you are completely healed. You should follow up with your plastic surgeon so that he/she can evaluate you, address your concerns, and develop a plan of care. Best of luck!
Matthew A. DelMauro, M.D.

Tom J. Pousti, MD · Answer

I am sorry to hear about the problem you are experiencing. You are correct that there has been a problem with blood supply to the nipple/areola complex. Fortunately, this appears to be mainly superficial, although hard to tell exactly how "deep" the tissue involvement is (across the entire areola).  Assuming  only superficial loss of skin results, you should be healed within one month and be able to enjoy swimming etc. in the summer months. Best wishes.

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