Breast Skin Necrosis After Mastectomy and Immediate Breast Reconstruction
If you have breast reconstruction with implants or flaps at the same time as a mastectomy (called immediate reconstruction), sometimes the breast skin doesn’t heal properly because the blood vessels that supply blood to the tissue are damaged. Sometimes, the skin might get thinned out too much after the surgeon removes tissue during a mastectomy. When there isn’t enough blood flow to the skin, portions of the skin on one or both breasts can wither and scab over. This breakdown of tissue is called necrosis.
Causes of skin necrosis after mastectomy
After a mastectomy with immediate breast implant reconstruction or flap reconstruction, breast skin necrosis may develop because of the following reasons:
direct blood vessel injury, which is normal for any surgery (especially surgeries that require significant tissue removal, such as mastectomy, nipple-sparing mastectomy, lumpectomy, breast reduction, or breast lift); as soon as a surgeon makes an incision for any procedure, there is a disruption in blood supply
breast skin that doesn’t heal properly because it’s thinned out too much after a surgeon removes tissue during a mastectomy
the mastectomy incision isn’t healing
a blood clot
microvascular dysfunction, which means that small blood vessels don’t work as they should, causing a disruption or reduction in the blood supply
tension in tissue that has been pulled too tightly and sewn back together and wound tension that can compress blood vessels and block them, leading to decreased blood supply
Symptoms and signs of skin necrosis
The signs of necrosis after mastectomy with immediate reconstruction are the same as the signs of necrosis after breast lift and breast reduction — procedures you might be interested in having as part of breast reconstruction or corrective breast reconstruction surgery. Symptoms of necrosis include:
redness and tenderness
blisters
swelling
dark brown, dark blue, or black discoloration of the skin
scabs
open wounds
fever
Look out for signs of nipple necrosis after mastectomy and tissue flap necrosis. If you have any signs of skin necrosis, let your surgical team know right away so you can get treatment as soon as possible.
Risk factors for breast skin necrosis
The following factors can increase the risk of developing skin necrosis after surgery:
an implant that is too large for you: an implant that is too large can put extra pressure on fragile skin
a large amount of tissue removed during surgery: if the surgeon has to remove a lot of tissue, it increases the risk of skin necrosis after surgery
smoking: smokers tend to have lower immunity, poorer wound healing, clogged blood vessels, and low blood oxygen levels
diabetes: people with diabetes tend to have blood circulation issues, especially if their blood vessels have narrowed; healing also tends to take longer for people with diabetes
bacterial or fungal infections: these infections can disrupt blood flow to the skin; your surgeon might have you shower with an antibacterial soap or body wash before surgery to help keep bacterial or fungal infections at bay
obesity: when the body carries extra weight, it has to work harder to pump blood; the extra weight can also put extra pressure on the arteries, all of which can compromise blood and oxygen flow
drinking too much alcohol: drinking in excess can affect the body's ability to heal after surgery
Is skin necrosis preventable?
Unfortunately, there is nothing you can do to prevent skin necrosis after surgery, but there are a few helpful steps you can still take:
keep the incision site clean, covered, and dry
wash your hands frequently
change your bandages regularly
follow your post-surgical (or post-op) wound-care instructions precisely
if you smoke, stop smoking, even if it’s just before and after you have surgery
Treatments for breast skin necrosis
If you only have a small amount of skin necrosis, it might heal on its own, but you should still let your surgical team know. Your surgeon might trim away some of the dead tissue, treat the area with basic wound care, and prescribe antibiotics.
If you have a larger area of skin necrosis that is not healing — for example, an area the size of your palm — the dead tissue needs to be surgically removed. Your plastic surgeon may have to replace some of the skin using a skin graft (skin taken from another place on your body). If the breast tissue has become infected, your surgeon may also need to remove your implant or tissue flap.
Some doctors also treat skin necrosis with hyperbaric oxygen therapy (HBOT). During HBOT, you sit in a pressurized chamber and breathe pure oxygen. Your blood carries the extra oxygen to the injured tissue, promoting healing. 1
After skin necrosis
A few weeks or months later, after the skin has healed and any infection has cleared, you might be able to have another surgery to smooth over any distortion to the breasts that may have resulted from the skin necrosis.
1. Mayo Clinic. “Hyperbaric oxygen therapy.” Available at: https://www.mayoclinic.org/tests-procedures/hyperbaric-oxygen-therapy/about/pac-20394380
This information made possible in part through the generous support of www.BreastCenter.com.
— Last updated on October 12, 2023 at 5:19 PM