What is the likely outcome after nipple and areola necrosis? (photo)

Question

I had bilateral mastectomies for breast cancer stage 1 and upfront implants. I was a B cup and the plastic surgeon placed D implants because I "breast fed" and was "ptotic". The nitropaste was not started till POD 1 late at night and after 3 days changed to Silvadene dressing. What is the MOST likely outcome? Local wound healing or removal of implants, even with good wound care with Silvadene and dressing changes? Thanks

John Paul Tutela, MD · Answer

Thanks for reaching out.  After skin necrosis, as long as the implant itself is not infected the likely final result will be a smaller breast with a vertical scar down the center of your breast, possible also horizontally as well.  If the implant is in fact infected it will need to come out and you should wait 2-3 months before starting off with a tissue expander.  It is really important to see your plastic surgeon right away and see what options are available to you.  Sometimes after failed implant reconstruction converting to autologous reconstruction where you use your own skin and fat to make a breast can be a viable option.I hope this helps :)

Farhad Rafizadeh, MD · Answer

I am sorry that you have to go through this ordeal, but at this point, it is important to try to save the remaining skin on the breast for a good reconstruction. The picture shows that the implant is ready to be exposed. It would be good to know if an ADM was used. The current implant needs to be exchanged for a smaller implant or an expander. After going to a smaller implant a mastopexy should be done which will result in an inverted T or a vertical scar. This should be done as soon as possible to avoid infection and be able to continue the reconstruction. If infection sets in the implant would need to be removed. The final results can still be good, but the nipple needs to be reconstructed. If an expander is used, one might be able to achieve the same size breast over time, but the best scenario would be with a smaller implant and a mastopexy pattern on both sides. I am giving you all this information so that you can discuss all this with your plastic surgeon. He obviously needs to feel comfortable handling this complication. I would urge you to remain positive but vigilant in dealing with this problem. Remember the final results could still be good.

Anthony J. Taglienti, MD · Answer

Thank you for your question. Your most likely outcome is local wound care with slivadene and dressing changes. From your photo it looks like, at this point, your implants can be salvaged. But, it's a bit of a waiting game until the area declares itself / depending on the thickness and viability of underlying tissue. The best thing for you to do is to increase your protein intake, be vigilant about your dressing changes, and try and be as positive as possible - complications like yours can happen; but the good news is that, in time, your result will likely be only slightly affected (if at all).Best of luck!

Keith Denkler, MD · Answer

Your current treatment plan sounds good.  Your PS will try to heal the wounds and maintain your implants.After you are healed, a new plan can be made to revise the scars from healing.

Samir Shureih, MD · Answer

Nipple sparing mastectomy has some potential risks, nipple loss and skin loss is a possibility.Based on the pictures posted, you seem to have full thickness loss of skin and nipple.The implant may have to come out. Treat the skin loss. There are many options. Then continue with reconstruction of the breast and there are many options. All options, risks and alternatives should be discussed.

What is the likely outcome after nipple and areola necrosis? (photo)

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