Nipple Areola Necrosis? (photo)

    The nipple areola necrosis you have should be examined to determine if anything further needs to be debrided.  At this point, the area will need to heal.  Then a revision can be contemplated after healing is complete.  You may be able to get to the result you seek, but it will take a little longer.

The picture demonstrates a significant wound with loss of the areola and fat necrosis. Healing will take a number of weeks because of the poor blood supply to the fat in the breast. Attentive wound care will be necessary for good result. The areola will probably have to be reconstructed secondarily.

It appears that have have near total loss of the nipple and areola.  Did this happen on both sides or just one - it is hard to tell from the pictures.  In either case, you need to follow closely with your plastic surgeon with aggressive wound care.  Eventually, you may need a skin graft and tattooing to help reconstruct your nipple & areola complex. 

Although I agree with the doctors below that your wound will heal with current treatment I would recommend a surgical debridement. There is a significant amount of necrotic (dead) tissue which must be removed. Once the dead material is gone your body will be able to heal your open wound quickly and allow you to proceed with the nipple reconstruction you will require.     

Dear Geminit

I am sorry for your complication after your breast reduction.  It appears that you have a full thickness loss of the nipple, and most of the areola.  More than likely when this fully heals, you will require a revision in order to improve the shape and look of it.  I would contact and be evaluated by your plastic surgeon to see if any more excision of tissue is required in order to improve the healing of the area.

Good luck in your endeavors

Robert Kratschmer, MD

I'm sorry to see/hear about the complication you have experienced after breast reduction surgery. As you know, it will likely require several more weeks of dressing changes and minor debridement procedures before the wound has completely healed. As time goes on, you will notice that the tissues will look healthier ( with more red tissue and less yellow/brown tissue).

In the longer term, you may benefit from the nipple/areola reconstructive procedures. Patience will definitely be  necessary;  sometimes multiple “smaller” procedures are necessary to achieve the desired outcome.

Continue to follow-up with your plastic surgeon. Best wishes for a long-term outcome that you will be pleased with.

It will takes several more weeks of topical wound care until the eschar comes off from your near complete nipple-areolar necrosis. Once you get a good bed of granulation tissue, you will need to consider a skin graft to expedite the healing. Nipple-areolar tattooing can then be done 3 to 6 months later.

You do have some necrosis which may require more debidement.  I am sure you are being monitored by your doctor.  This will heal with a bit more time.  A small scar will result and then you can get reconstrucions of your nipple areola complex on both sides.  It will be a multiple month process.

Talmage Raine MD FACS

drraine.com

You need to be seen by your PS and hopefully weekly right now to evaluate and treat the tissue that appears to not be alive. The process will take a while, but there is no way to predict cosmetic outcome. There are methods to reconstruct the nipple and areola.