7 weeks post op, free nipple graft keeps scabbing and bleeding. Any suggestions?

Question

7weeks post breast reduction, free nipple graft keeps scabbing over and then bleeds and cycle begins again, not sure what to do, going round in circles, PS says no infection, if I cover them bleeds if I don't cover scabs then bleeds, any suggestions please

Richard H. Tholen, MD, FACS · Answer

Free nipple grafts (indeed, any skin graft) do not contain sweat or sebum glands (these reside below the skin and are not part of the nipple graft), and therefor are naturally dry and flaky without their own natural lubricant. This can lead to cracking, scabbing, and then bleeding when the dressings or clothing that touch these areas are removed.The lost or absent lubrication must be provided externally, as any good burn surgeon will tell you (lots of skin grafts). Most plastic surgeons have extensive training in grafts and burns, so this should be second nature to the well-trained plastic surgeon.You don't need nonstick or greasy dressings; you need Lubriderm, Vaseline Intensive Care, Nutraderm, Oil of Olay, Bio-oil, etc. applied until the skin grafts heal and then continuously to avoid cracking, flaking, and ultimately, scabbing and bleeding. You have to break the cycle, and lubrication may need to be applied more than once a day for long periods of time, or at least until your adjacent normal skin glands can lubricate the nipple grafts adequately.In the meantime, a non-stick Telfa or other medicated petrolatum type dressing whould allow the grafts to heal. But lubrication is the key. Best wishes! Dr. Tholen

Tracy Kayan, MD · Answer

Any skin graft can take some time to heal/close up completely, and the skin may always be more sensitive to shear or rubbing, so make sure your bra or dressings are not rubbing against it. Also, if there are any open areas these can stick onto gauze and tear a layer of scab/skin off when you remove the dressing, so try placing antibiotic ointment (bacitracin, triple antibiotic ointment) on top of the wound and place a non-stick dressing such as telfa, adaptec or xeroform on top of this. These can be obtained with a prescription or sometime over the counter as well. Best of luck.

Allen M. Doezie, MD · Answer

I would suggest keeping an antibiotic ointment on the wounds, covering them with a non-stick or petrolatum gauze.  Should do the trick.

7 weeks post op, free nipple graft keeps scabbing and bleeding. Any suggestions?

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