Is This Wound Separation?

Thank you for your question and for sharing your experience with us.
You will find that every few days the wound will get smaller. Once the
wound closes, it will go through a great deal of remodelling and in many
cases become very acceptable in appearance. If there is a remaining
indentation or widening of the scar that is unacceptable, then I would
recommend waiting six months to year before undergoing any minor
revision. It is important that you stay in touch with your surgeon
throughout this process.

Your pictures demonstrate wound separation along both
the transverse and vertical limbs of your breast closure.Unfortunately, wound separations aren’t
unusual following this type of procedure for a variety of reasons.When patients
undergo breast reduction, skin flaps are wrapped around a central pedicle of
breast tissue that supports the blood supply to the nipple areola complex.The area where the transverse incision meets
the vertical incision is at significant risk for breakdown because the flaps in
this location may have poor blood supply.In addition, the weight of the pedicle may exert significant downward
force upon the closure where it’s weakest because of poor blood supply.In
patients who have extremely large breasts the skin may manifest significant
thinning.Under these circumstances
sutures may not hold which might lead to breakdown as well.Furthermore, these patients have high levels
of bacterial and fungal growth from years of rashes beneath the breast folds.This can also significantly affect the
potential for wound separation.Wound
separation following breast reduction usually heals nicely with local wound
care and dressing changes.Rarely they
become secondarily infected and require antibiotics as well.Scar revisions are occasionally necessary,
but this is unusual.Even
when breast reduction patients have areas of wound separation, the clinical
results following this procedure are excellent.After wound healing is complete levels of patient satisfaction are high
as well.

It appears that you have some necrosis and separation at the inverted T scar area. This is the area of the wound where the tension is the greatest and this problem occurs here with some frequency.  The area usually heals with local care and the scar is acceptable.

Separation, or dehiscence, of breast incisions can occur for one or more of several reason:

1) Too much tension on the skin incision (inadequate volume reduction)

2) Tobacco use (smoking) before and after surgery compomises circulation to the skin

3) Need for re-operation (i.e. for a hematoma) can cause additional trauma to the tissue

4) Previous radiation (breast cancer patients)

This is very common in this area and may result in a slightly thicker scar but will trypically heal within 3 weeks with good wound care.