Q: Unexpected necrosis of nipple from 04/04 How long does this take to heal and how is it repaired? (Photo)
I advised dr my nipple was dark looking while in hospital post OP and he advised it was no big deal. The next day it was completely black and my breast was swollen with blood oozing from behind the nipple and out of stiched and he still said it will be fine. 4 days later he removed my areola and nipple and left me like this with only wet dry would reassigns until the wound declares itself ( which I have no idea what this means) how common is this and how to fix
A: Very difficult situation
It is so difficult to have this happen. Unfortunately, this is one of the worst risks of this surgery, the pedicle has inadequate blood supply to maintain the viability of the nipple and areola. It is typical for the nipple areolae to be a little dusky in some people after surgery and by the next day the color improves because often a vasoconstrictive solution is used which limits blood loss during surgery. At this point, it is a very long road to full healing. You basically have to undergo debridement of all the tissue which is not receiving adequate blood supply to survive and this process is best done slowly so that you do not remove tissue which may survive in the long run. Over the course of the next 3-6 weeks, blood supply will establish in the pedicle and eventually you will develop a vascularized tissue called granulation tissue. Once this forms, you know that all the remaining tissue is going to survive. After about 2 weeks with a healthy granulation tissue base, the open wound will suddenly contract down and close. There is no way to speed the process. After a year, the tissue will be soft and the scars will be barely visible and the breast may look very good. Depending on how much of the pedicle died, you may need further surgery or possibly want to have an implant to achieve symmetry. You will also have to have a nipple areolar reconstruction. This is a very difficult problem for you in many ways but is a real risk of the surgery. Since the blood supply to the breast tissue which is left under the nipple areolar complex is different in everyone, there is no way to fully assure that this problem will not happen. Try to be patient and just let your doctor treat you slowly over the next 3 months until it heals. In a year, when all the scar tissue is broken down and remodeled, you will likely have a better looking breast than you can imagine now. You may need further surgeries but there are solutions to the problem which is the most important thing to remember.