Skin Necrosis 6 days after mastectomy

Robin64

Hi all, greetings from Canada, (Vancouver to be exact)

I have been looking at various discussions on the Breast Reconstruction Forum but haven't been able to find much about necrosis.

Six days ago I had a one sided simple mastectomy with immediate silicon implant and Alloderm. Today I saw my PS for the first time since. I was excited to see the result as she removed the large pressure bandage from my chest. My first impression was good. From the top, the implant looked great though a little inflamed around the incision line. But then my husband asked the PS, "What's that black area?" on the lower breast (larger than a quarter). PS looked concerned and said that my skin was not well perfused in that area. She cleaned the whole breast, applied antibiotic cream and also applied nitroglycerin cream which studies have recently shown to help expand small blood vessels. She then applied a new, smaller sterile bandage and has me booked to have the wound cleaned and dressing changed twice more this week before she sees me again on Monday. She was clearly not ready to make any specific pronouncements about the fate of the implant or my skin, and prefers to monitor the situation closely over the next while. She did, however, say that she would have to debride the area in the future, and she implied that depending on the success of that, the implant may have to come out. Meanwhile I continue to take a course of strong antibiotics.

After a host of life challenges this year, and after debating between recon or not, then waiting a long time for my surgery, I am reacting to this more emotionally than I would like - and am writing here to ask if anyone has any pearls of wisdom about necrosis. My fears and questions?

Why is PS not being more aggressive with my necrosis problem? I see on this site a few random mentions of hyperbaric treatment, but this doesn't seem standard.

Should I not be having the debridement now rather than later? Or is it better to wait and see?

Does anyone here have any experience with nitroglycerine cream in this context? Are there other products that would be better?

Are there general or nutritional ways I can promote healing of this patch of skin?

Or am I just tilting at windmills? Is that patch of skin in fact just dead and gone, and we now go back to surgery as soon as possible to remove the implant? While I would not opt for any further recon, I imagine the current skin damage will also adversely affect the look of the next mastectomy scar?

Many thanks for any help you can offer.

Best regards,

mary625

I had skin necrosis after mastectomy without recon. I can only share my experience in this context with a breast surgeon--no PS. It's my understanding that what has to happen is that the skin has to rebuild from the inside out. As that starts to happen, they may do debridement. I don't know if sooner rather than later is better on that. I was given a cream called Silvadene to use. There was oozing from the site for awhile. It took about two to three months to heal, and it scarred badly.

I don't think it means that you're in danger of losing your implant. It's not the same as a wound opening. But maybe with a PS something can be done for a better cosmetic result. My scarring is now gone as part of my DIEP recon.

Best wishes!