Is this normal, or should I be worried? (Photo)

I had a breast lift with saline augmentation 2 weeks ago, the steristrips irritated my skin,and now my plastic surgeon is using silvercel non-adherent dressing. He also put me on antibiotics. Is it normal for my areola to look like this at this stage?

Doctor Answers 8

Is this normal, or should I be worried?

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Hello dear, thanks for your question and provided information as well... I have to say that you have developed a necrosis on your areola, I suggest you to get to your surgeon as soon as possible, talk about this and always be in touch, hugs!

Nipple necrosis

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You look to be experiencing nipple necrosis. Continue to follow your surgeon's advise to the T and let him or her know if anything changes. So sorry that you are experiencing this. Best, Dr. Nazarian

Nipple necrosis is not normal

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There are significant risks associated with mastopexy and augmentation at the same time.  It was not the stern strips.  The combination surgery caused a failure of the blood supply to the nipple and partial nipple necrosis.  Only time will tell what portion of the nipple will heal.  If the implant becomes exposed it will have to be removed.  

A lift with an implant is controversial for two reasons. First, when you perform a lift you are making everything tight and closing the wounds under tension. It you add the expansive forces of the implant at the same time, you are fighting against yourself. There are forces on the wound which try to make them separate, which results in wider, thicker, more irregular scars. In the worst case, the wounds will open. So compromises are usually made in the operating room by the surgeon because they cannot close the lift wounds over the appropriate sized implant. Either less of a lift is performed so that the skin is not as tight and therefore there is less tension on the closure. Or a smaller implant than would be appropriate is used so as to decrease the expansive forces. Either way, you are compromising the aesthetic outcome. Often the outcome is so compromised that a second revision surgery is required. If however, you plan to have the lift first and then the augmentation after everything has healed, then you have two operation that are planned, both with much lower risk than the combined mastopexy/augmenation. The outcomes of the two meticulously planned operations are much better and a more aesthetically pleasing, and a safer outcome is achieved.

The second reason the combination of mastopexy and augmentation is controversial is because of the risk of nipple necrosis (death of the nipple). By making the skin tight for the lift, you are putting external pressure on the veins that supply the nipple. By putting an expansive force on the undersurface of the breast with an implant, you are putting pressure on the thin walled veins that supply the nipple. If the pressure by squeezing the veins between the implant and the skin is greater than the venous pressure in the veins, the flow will stop. If the venous outflow stops, the arterial inflow is stopped. If the arterial inflow is stopped, there is no oxygen for the healing wounds and the tissue dies.

Placing the implant on top of the muscle in combination with a lift puts the blood supply to the nipple at a much higher risk because in addition to the issue of pressure on the veins, you have to divide the blood vessels that are traveling from the pectoralis muscle directly into the breast (and to the nipple) in order to place the implant between the breast tissue and the muscle. This adds a third element of risk to an already risky operation. Mastopexy/augmenation with sub glandular implant placement is by far the riskiest way to address your anatomic question.

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Is this normal

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Hello and thank you for your question. It looks,as though you have some superficial skin necrosis associated with a mild infection. I believe your ps is treating you appropriately. 
This should resolve without much problem. Follow your doctor's instructions obsessively. 
Peter Fisher M.D 

#breastimplants #breastsurgery

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Thank you for sharing your photos.  As i can see in your  photo you have an  superficial epidermolysis in the nipple  this  has  different ways to handle, contact your ps and follow his instructions. 

I hope my answer will help you to your question.

Before undergoing any surgical procedure, please seek a board certified plastic surgeon

Jairo Ulerio, MD
Dominican Republic Plastic Surgeon
5.0 out of 5 stars 92 reviews

Should I be worried after my lift.

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Healing problems are always a worry, and your photo suggests some poor circulation in the nipple. See your surgeon frequently and follow all instructions and he should see you through.

Is this normal?

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From the photos you have provided it looks that you have what we call epidermolysis where the very superficial portion of the skin has sloughed over a portion of the areola. This usually improves with standard supportive measures such as the one your plastic surgeon has described. It may take a few weeks but should look just fine. Congratulations on your surgery and good luck on a further recovery.

Breast lift

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Depigmentation after the lift should resolve over time.  There are no topical ointments or creams which would safely stimulate melanocytes.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.