Black nipple
I'm sure this might be discussed elsewhere but I cant find it. Applogies.
One nipple has turned black, seems "flat" against the breast. I'm afraid to go to my PS tomorrow.
History here is - Initially invasive duct. carc. in left breast, oncologist didnt like the way something in the right side felt so sent me for an MRI of both sides. Even though the mamogram found what I found in the left side, and said no evidence of malignancy in right breast. MRI did find something in the right side, biopsy confirmed. I did chemo first, started in July. Dose dense schedule, A/C every two weeks, 4X, followed by taxol every week. "Clips" placed mid point. Done Nov. 29. Had what they called "complete clinical response".
The docs still wanted to remove tumor bed, BC runs in my family and always comes back so I opted for bilateral "skin and nipple sparing" mast. (Second surgeon I found told me about, and I was candidate for) Did not like the first surgeon who wanted to just chop. Would not do radiation, it messed up my mom.
Did the BMX 01/03/11. Not as bad as I thought it was going to be but no picnic. TE placed and 100cc put in each one at time of surgery. So I woke up with lumpy small foobs. One week post op two of the four drains came out, and I felt much better. I'm very thin and was not big busted to begin with.
Two week post op visit the breast surgeon thought things looked good. Next appointment, oncologist, he was very positive. Third appointment of the day, plastic surgeon. I was looking forward to the remaining two drains comming out. No. He did not like the way things looked at all, next thing I knew I was being given a local, sliced open, a small bit of skin removed from each side of each incision to get to fresh hide and stiched/glued back shut. I was confused because the breast surgeon liked the way things were looking- PS said sure if you dont care what it looks like down the road. I have one slice about three inches long on the outer side of each breast. Did not slice into the nipple, stops about 1/2 inch from the nipple.
The PS I picked was also the second one, first one was horrible. Told me I was to picky and at 48 it really didnt matter... This one was more of a geeky perfectionist and his pictures looked much better...
Week three the remaining two drains came out- MUCH better.
I am supposed to see the PS tomorrow, he wants to start filling. I'm afraid he is going to look at the black nipple and mess with that. The breast surgeon (last week) said to just give it time and not pick at it. Apply gooey antibiotic ointment 2x per day. The black "stuff" surrounding the nipple has started to flake off/come off in the shower, raw looking skin underneath, but the nipple itself is still very black. Hard crustlike, like a little shell, stuck, black.
Has anyone else had this happen? The other side (nipple) looks almost like it did before surgery. Did have some black crustiness but that came off.
I'm also afraid of the fill idea. When he resliced two weeks ago, he took 50cc of fluid out first. I was expecting relief so it really suprised me to suddenly feel like a railroad spike had been placed on my chest with a cement block balancing on top of it. I dont think it was a muscle thing, more my ribs that hurt so much. Hard time just breathing! He did not refill after reslicing. The ride home and the next few days were more painfull that comming home from the initial surgery. Felt like I was knocked back to square one recovery wise.
I am just starting to feel functional again, work at a very small business and have had to go back like it or not or we go out of business. Only last a few hours a day, just enough to get the paperwork part done. Cant afford in many ways to get knocked back to square one again.
Almost wondering if this is worth it. In the back of my mind I am thinking if they want to do anymore slicing (nipple) I am going to tell him to take these expander things out and call it good. I'll droop like I'm 90 but am starting to think I might not care. My other half starts to yell at me when I am in pain so I really dont want to go there again.
If anyone else has had this black nipple or had fluid taken out then put back in I'm all ears for any advice, so flipped out about tomorrows appointment I might not go. I guess I am really concerned about the still black nipple, but also wondering if the fill process is going to be as painful as removing the fluid was.
Comments
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I don't have any experience with this, but so sorry to hear you are going through it. BUMPING your post so that some other ladies may have a chance to see it and comment. take care...
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BUMPING again - any nipple sparing MX ladies out there who can comment?
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What you have is necrotic skin, happens in about 20% of skin sparing, nipple sparing cases. Your docs should have informed you about this risk. Mine was about the size of a 50 cent piece, below and to the inside of the nipple. If it is flaking off on its own you should be fine. You should be coating it with Silvadene cream (prescription) twice daily. My cautionary tale - mine burst open and I have had 3 surgeries to close it, the last removing the TE on that side. I now have to wait 6 months until I am done with chemo to put it back in, so I am mis-matched!
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I also had bilateral mastectomy w/skin & nipple sparing on 2-17-09. My PS said the black nipple is a scab, do not pick at it as premature removal will cause a pit. Let it fall off on its own. It took 3months to fall off in the shower. I protected it with gauze pads under bra day & night. PS was right & it was worth the inconvenience. Nipples look great & normal. We joked every time I saw PS about how long it was taking. I said the scab was really an alien life form, but all is well. Leave it alone!
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Thanks for the replies, guess I will keep the appointment this afternoon and just tell the PS to leave it be. Bettypage, If yours turned out OK and took three months to fall off, guess I will just wait and see. The PS seems to be in a hurry to get things moving every time I have seen him.
I just wish I knew what I was in for first fill wise, since it hurt like h*ll removing fluid, which I really didnt understand. Was expecting the opposite. The last 7 months or so have been kind of rough but I think I was handling OK. All the sudden I feel like I just have had enough. Might be these tamoxifen pills they started me on. Just wish I knew.
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wanaB Ihope your appt went well and you found out that the black nipple is part of the healing process and not the sign of nipple loss. I had a black nipple, too, that stayed around for about a week or so. It fell off and my skin underneath was so smooth and pink! I hope that is the same for you.
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Figured I should post an update for anyone else going through this. Kept the appointment, the PS agreed to just leave it alone and keep gooing it with bacitracin. Its still black and still stuck.
It has been 6 weeks since the initial surgery, 4 weeks since the reslice/restich. I keep telling myself dont panic, bettypage said hers took three months....
Although the removal of fluid from the expanders at two weeks hurt like hell, he did put 50 cc only back in, and that didnt hurt. Might actually feel better since. Still not sure how removing could hurt so much but refilling didnt, but for what it is worth for anyone else that might have that experience, I'm glad I kept the appointment now.
I was really thinking this reconstruction idea was perhaps not for me.
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Not a good update. The black crust started to look like it was separating. I followed instructions to not pick, keep it gooey. In the shower it decided to let go- almost. Still attached by a small bit of skin, hanging like a flapping flag. So I cut it off.
The bad news is it was not a scab, it was my dead nipple. There isnt a nice new one underneath. No hole or pit either, just smooth skin where the nipple should be. Yes I'm bummed.
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So sorry for you. Did you call your PS and tell him about the nipple falling off? I had a BMX with nip sparing and both my nips were black as night. The cancer side had a huge wound that looked like it wasn't going to make it, in addition to the nipple and areola area that was also a questionable blackish/greenish/yellow color. This breast looked like I had two areolas because the wound is that big! Slowly but surely the skin started turning redder, which is a sign of circulation. The non-cancer side nip finally shedded the black skin, showing a pink little nip. Not as big as it normally would be, but at least it survived!
The left side looks a little pinker under the black, so my fingers are crossed that everything will heal. I have that side covered 24/7 with non-stick gauze and neosporin under it.
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Did one better than call. I had an expander fill last thursday again and this happened in the shower just before heading out for my day of appointments. I suppose I could have just tried to stick it back in place, but he said he would have cut it off anyway so no harm done. Laugh, I put the snipped off part in a ziplock baggie and took it with me. I live with a smoker so in earlier visits there were stern words about smoke, but at the last appointment he didnt touch that "blame" subject, said sometimes it just happens. Says he can make me a new one, after reading a thread on that I might just figure it is what it is. I dont like surgery. This side was flat from day one, the other one stuck out like a nipple. Both sides went through that strange purple/green/yellow stage, just the left side turned so black and stayed that way. The other side looked more like a scab, is fine now. I guess I knew it didnt look like a scab on the left side when I initially posted the question. Guess it wasnt.
I hope yours turns out OK.
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