Breast reduction/lift resulted in areola/nipple necrosis. Going through debridement. What should I do next? (Photo)

Question

Directly after surgery I had a black areola/nipple complex. My PS mechanically debrided. Seeing a wound doc and using santyl. I have a large deep wound but some areas on the sides have good blood supply. The wound doc initially said it could close on its own but now we have found more necrosis further underneath. He now says surgery may be required. He also suggested hyperbariac chamber. Can I let it close up around fat necrosis or should it come out. Rash also under both breasts.

Vincent N. Zubowicz, MD · Answer

Eventually all the dead material needs to be removed from the one before closure will ensue. Sometimes this is hasten by an operation. Even without surgery however the body will eventually removed the dead material in close the wound. Whether or not operate is a judgment call. I doubt hyperbaric oxygen will be of any benefit.

John Michael Thomassen, MD · Answer

I'm sorry for your complication.  At this point I would recommend that if there is residual necrotic tissue in the area of the areola it be debrided fully.  This does not need to be done in the OR necessarily depending on how much is necrotic.  If limited it can be done in the office setting.  Fat necrosis may need to be excised also depending on how extensive it is.  One option to speed up the healing is to redo the reduction/lift to reduce the size of the breast further and close the apical wound on the breast.  This may affect the areola on the opposite side so it may not be recommended by your surgeon.  Allowing it to granulate and heal after debridement may be safer but will take longer to heal.  Eventually it should granulate, reepithelialize and you can undergo a nipple/areola reconstruction.

Curtis Wong, MD · Answer

can be quite distressing as my own patients have experienced it.  Debridement of the yellow material should be done aggressively and in my opinion, wound doctors do not do it as well as plastic surgeons.  This will allow for your wound to heal faster.  As for hyperbaric oxygen, unless you have some underlying issue that impairs blood supply, it really isn't indicated in my opinion and will only add to the cost of your recovery.

Breast reduction/lift resulted in areola/nipple necrosis. Going through debridement. What should I do next? (Photo)

Answers (3)

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