WARNING: NSFW / graphic content below.
What is necrosis?
One of the risks associated with a mastectomy, or any surgery, is tissue necrosis. This occurs when the blood supply is compromised and the cells aren’t receiving enough oxygen; the skin begins to die. As this happens, it turns black and hardens into a scab. Although the dead tissue can be removed (debridement), it cannot be brought back to life. Hyperbaric oxygen therapy (HBOT) can be used to treat surrounding tissue – more on this in another post: Hyperbaric oxygen therapy.
Breast skin is fragile after mastectomy. If it’s exceptionally thin after the breast tissue is cut away or is handled too roughly, it may die. The same result may occur if the breast surgeon severs too many blood vessels that feed the skin or uses eletrocautery too aggressively and burns the inside of the skin, which may then blister and die.
– Steligo, Kathy. Breast Reconstruction Guidebook: Issues and Answers from Research to Recovery. Maryland: The Johns Hopkins University Press, 2012. Print, third edition.
My case
Nipple necrosis was one of my big worries when I was struggling to decide whether my prophylactic bilateral mastectomy was going to be nipple-sparing. I did a lot of research and talked to both of my surgeons about it. Check out my earlier posts on the topic: Nipples, pecs,bras, OH MY! and Let’s give them a chance.
Left nipple day of PBM
I had the unfortunate chance to experience necrosis in the area of the left nipple and skin directly underneath it. The day of my surgery, we could already see that there may be a problem. The left nipple looked “dusky.” On day six, the sterile strips covering the bottom of the nip and the incision underneath it were removed and we discovered a bit of a mess there as well. In the next 24 hours, the area turned black. A little panicked, I reached out to my PS for his guidance. I was told to just sit tight, because there really isn’t anything that could be done. I washed the area with anti-bac soap and kept an eye on it.
Over the coming days, the small area of necrosis changed shape a bit, but did not get better. Check out the images below, which show the changes over a two-week period. The day I wrote this post, 18 days after PBM, some of the scabs on the nipple have fallen off, revealing bright pink skin underneath. The larger area of necrosis under the nipple is still covered with a tough, black scab. I have had four hyperbaric oxygen treatments in an effort to minimize the damage. More on that here: Hyperbaric oxygen therapy.
I am told that my nipple will be fine. Worst case scenario = scarring or discoloration in the area below the nipple as the scabs fall off. We shall see. I will post an update when that occurs.
2/22: Scab is slowly lifting up.
7/12: Scab is long gone and the pigment has returned.
Saying NOPE to Breast Cancer 
So was all of your breast tissue removed from that incision that is shown in the picture?
Yes, ma’am.
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I had a nipple surgically created. It turned black and the whole thing fell off when I was in the bathtub. Unnerving experience! Reconstruction on radiated skin is difficult as the skin is so thin and non elastic. I had a big black area on my uninflated chest for about 3 months after the mastectomy. Somehow they managed to save things but I’ve blocked out the memories until I saw your pictures.
That must have been unpleasant and I’m sure that’s an understatement! I’m sorry to bring back those memories. 😦 ❤
I am currently sitting in a hyperbariatric treatment facility having just had a bilateral nipple sparing mastectomy and i feel like this place is a money grab. I had surgery yesterday and now out of the blue they are talking about 30 days of treatment in chamber. I dont know enough to say yes or no, but having met my max copays it seems they are just milking insurance for every drop.
I’m sorry that you’re having to need this type of treatment. Do you have some necrosis? As I mentioned in my post, I can’t really say whether this treatment really helped, but other women in this situation think that it did. It sure didn’t hurt and I was in the same boat insurance-wise, so went for it.
I recently saw a medical show that used leaches for this problem. Worked fairly fast. Worth a try.
I saw that too! On Botched, right? That was interesting. I’ve never seen or heard of that before.
Seems like it would be a great thing we talked about it on Facebook in the private groups i belong to and noby had heard of a Dr using it before either.
I just wanted to say thank you for your blog! I recently had a double mastectomy and I had a hematoma the day of my surgery and was rushed back into surgery that night.The Dr cut back into the same area he cut before and the tissue started to turn black the next day. It looked so much like yours. You have given me hope that this will be ok and will pass and I will be fine. I know it is a long road from reading your blog. Thank you for sharing your pictures and your trials. I am sorry for what you went through but I am glad you are doing better now. Thank you for giving me hope 🙂
Hi Tonia! Thank you for your note. I’m sorry that you had to go through that too :(. One day at a time. You will get through it and some day it will be a memory. How are things looking now? I hope healing well. Thanks again! ❤
Hi 🙂 I am doing much better. The wound is just about closed. Just this week I got the ok to not wear a bandage 24/7. That is a great relief especially since I started my Tamoxifen and I am having one hot flash right after the other. Do you have any suggestions for that? As I type this I am dripping sweat. lol
Well, I’m glad you are doing better! I don’t have any Tamoxifen or hot flash experience, so afraid I can’t contribute anything useful there. I hope the healing continues to go well!
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I had a prophylactic double mastectomy 18 days ago and my right nipple has a small scab on the very end and my PS told me it will fall off. I’m not worried about that but did notice the areola is not as pink as it was. How long after the surgery should I worry about necrosis?
Thanks for the note, Leigh Anne. Mine was visible the day after surgery, so I would think it would happen pretty quickly if circulation was going to be an issue. Many women have scabs that do fall off, just like your doc said, and there’s bright pink skin underneath.
Dear,
what complete case took time for eschar fall of and pigment return?
Hello. The eschar fell off at approximately 6 weeks. Pigment took a long time, I think around 6 months, but not 100% coverage, so some pink is still there even now, 5+ years later.