After a mastectomy with immediate implant or flap reconstruction (which means it was performed during the same surgery), sometimes the breast skin doesn’t heal properly because the network of blood vessels that supply blood to the tissue were damaged. The skin may have been thinned too much when tissue was removed during the mastectomy. When there isn’t enough blood flow to the skin, portions of the skin on one or both breasts can wither and scab. This breakdown of tissue is called "necrosis."
Signs and symptoms of breast skin necrosis
Some symptoms of necrosis of the breast skin include the skin turning dark blue or black and eventually developing scabs and/or open wounds. You also may run a fever or feel sick.
It’s important to work with your care team to make sure you get the proper treatment for necrosis.
Who is at risk of breast skin necrosis?
You may be at greater risk for developing skin necrosis if your surgeon inserted too large an implant that is putting excessive pressure on the fragile skin. Also, if you smoke, are obese, or have diabetes your skin may be less likely to heal well after a mastectomy.
Treatments for breast skin necrosis
If you only have a small amount of skin necrosis, it might heal on its own or your doctor may trim away some of the dead tissue and treat the area with basic wound care in a minor procedure setting.
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
If you have a larger area of skin necrosis that is not healing — for example, an area the size of your palm — you will usually need to have surgery to remove the dead tissue. 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(s) or tissue flap(s) during this surgery.
A few weeks or months later, after the skin has healed and any infection has cleared, you could have another surgery to correct any distortion to the breasts that occurred because of the skin necrosis. Depending on your unique situation, your plastic surgeon might recommend, for instance, redoing your implant reconstruction if you had to have your implants removed, getting your nipples reconstructed if they were affected by the necrosis, or transplanting a flap of tissue from another part of your body to fill in an area of the breast where you lost some skin and tissue.
- Mayo Clinic. Hyperbaric Oxygen Therapy. 2018. Available at: https://www.mayoclinic.org/tests-procedures/hyperbaric-oxygen-therapy/about/pac-20394380.