Best Treatment for Necrotic Areolas, Nipples and Attached Scar?

That is a really unfortunate outcome, and I'm sorry you're going through that! Partial or complete nipple loss is a recognized potential risk of breast reduction, but thankfully uncommon. It is not clear to me what technique of reduction was used based on the photos. It looks like you have incisions extending on either side of the nipple areola complex. At this point, based on the appearance in the photos, I would recommend antibiotic ointment to the black and yellow dry areas until they soften and peel off (or are conservatively debrided by your surgeon). The end result may look better than expected. If nipple areola reconstruction is needed, and/or tattooing for pigment, this can be done once you have healed. Good luck!

I am sorry that you have had this difficult problem.  See your surgeon frequently so that they may do the best they can to help you through this process.  Most likely you should let it heal for a few months, then reassess for revision surgery and tattoos.

This is an unfortunate occurrence that you are going through.  Please listen to your surgeon as you go through the delayed healing process.  Wet to dry saline dressing may be sued or antibiotic topical such as Silvadene is frequently used.  After a period of time your surgeon will be able to see more clearly what is left and what is missing and determine which route to take on reconstruction of the nipple areolar complex.

I am sorry that you are having these difficulties, but this is the time when you follow closely with your surgeon and follow his/her instructions.

 

Fortunately nipple loss after breast reduction is uncommon, though for all surgeons in practice long enough, we know that the risk is a real one. I cannot recognize the scar pattern, vertical or 'T' from your photo, though we often debride conservatively when nipple loss occurs. We like a saline moist dressing until the degree of loss 'declares' itself and then clean the area and continue moist dressings until the wounds close. Often there is more recovery than what might be expected, and skin grafting and tattooing do indeed provide solutions to the problem. You will be in this for a long while with your surgeon.
Best of luck,
peterejohnsonmd

Hi W8297 in CA,

I'm obviously very sorry for the problem you're having.  Tissue loss, including the nipple and/or areola, are recognized potential complications that are, fortunately, very rare, but when they occur to you they don't seem so rare.

I would generally advise conservative management at this stage, with moist dressings and/or antibiotic ointment until the eschar (thickened, black tissue) has separated.  I would then maintain a non-adherent dressing until the tissue has healed.  As you indicated, further revision, possibly including tattooing, may be indicated, and this is a good time to stay in touch with your plastic surgeon.  Nobody's happy with this situation and I think you'll get the best ultimate result most easily if you can maintain your relationship with your own plastic surgeon.  Often the end result is not quite as bad as you fear it will be but, either way, a certain amount of work will be involved to get the best result possible.

I hope that this helps, and good luck,

Dr. E