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.

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.