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Nipple and skin ischemia possible necrosis complication

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MorningGlory27
MorningGlory27 Member Posts: 10

I had skin and nipple sparing mastectomy with infra-mammary incision and expanders 5 days ago. On the first day, the lower part of my left areola turned purple, the second day it was turning black and the skin under it was turning purple with bloody blisters all the way down to my incision site. I was prescribed Nitro-bid cream to apply every 6 hours. It has been giving me unbearable headaches. I am 5 days out and there have been no changes, the black areola is now grayish, most little blisters on the skin are just reddish purple, I have one blister that grew to a size of a bean. I have no feeling in the area but I am terrified that my nipple and skin is dying. Anyone had similar or the same complications and is there anything else I could do to prevent further issues such as infection and ultimately loosing my nipple?

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  • Captroynsteph1
    Captroynsteph1 Member Posts: 5
    edited January 2015
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    Hi MG27. I am going through a similar necrosis right now and just wondered how your situation resolved. I am scheduled for surgery on Friday to remove the tissue and replace with TDAP flap. All the best!

  • specialk
    specialk Member Posts: 9,221
    edited January 2015
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    Necrosis can be slow to heal and leave the previously necrotic area of skin thin and vulnerable going forward.  I would recommend eating at least 100g of protein daily - supplement with protein shakes if you can't get that much with food -  and also talk to your physicians about possibly using Silvadene cream, or another topical that will aid in healing.  You can also supplement with Bromelain (or eat a lot of pineapple), Arnica, and Zinc - but check with your physicians first.  Some use hyperbaric chamber to aid in healing but not usually until things have gotten worse.

  • MorningGlory27
    MorningGlory27 Member Posts: 10
    edited January 2015
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    So far there are no changes, except that the blisters popped and the skin is red there. I am inserting a picture for you guys to see it. I was told by my PS that is is ischemia and may resolve itself, I need to monitor to see if it gets worse. I also have redness, more pinkish skin on both sides where the alloderm is, my PS wasn't sure why so they changed my antibiotic to Bactrim. No changes there either. Supposedly it will take weeks for my black/purple spot to fade, peel. I really hope it wont get worse and I don't need that part to be removed, I feel for you Steph, we have already went through enough,

    Special K, you've been so helpful since I got on this site, thanks for all of your advices, I ended up not needing chemo yay, at least thats good news. On the protein, ugh you're asking me the hardest. I barely eat meat or nuts, I don't know how to get 100g in me daily. I guess I'll find some protein shakes or bars at GNC even though those taste nasty. I do want to heal though. Isn't Arnica a cream? I used to use that for bruises, can they go together with my other cream? I actually have another question, the area where the alloderm is attached to my muscle, I have an indentation all the way across and it feels tight, like someone put a rope around me and pulled it tight. Is that indentation ever going to go away? I assume the tightness will subside with healing.

    image

  • Captroynsteph1
    Captroynsteph1 Member Posts: 5
    edited January 2015
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    Here is mine. Dr. gave me the option of waiting and watching but felt like it would probably continue to die. I will post once I get my TDAP flap and let you know how it goes. All the best!

    image


  • MorningGlory27
    MorningGlory27 Member Posts: 10
    edited January 2015
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    wow looks similar to mine, except mine is bigger. Is that line under it your incision site? So are they removing it at the same time as the TDAP or are you going to wait to see what happens to it?

  • Captroynsteph1
    Captroynsteph1 Member Posts: 5
    edited January 2015
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    yes, that is my incision, it seems to be healing well. I'm only using the flap to replace this section of skin where my tumor was close to the surface. They had to remove more than they wanted here to get clear margins.Getting an implant for my reconstruction. Feeling pretty good. Completely off pain meds and drain total was down to 30mL yesterday. Too bad I go back into surgery tomorrow! I hope yours gets better on its own! So glad I got to meet someone else experiencing this at the same time.

  • specialk
    specialk Member Posts: 9,221
    edited January 2015
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    MG - several thoughts.  Alloderm can cause something called "Red Breast Syndrome" which would not be the major darkness you see, but could account for the pinkness bi-lat.  It is kind of an allergic reaction.  Keep a watch.  Also, usually the alloderm does relax a bit so things like lines and dents definitely change as your body starts to encase the alloderm with scar tissue.  For protein, maybe try vegan protein powder - that is what I use.  Plant Fusion or Vega - you can get it at Whole Foods, GNC might have it.  I just combine it with frozen and fresh fruit (usually berries) and some almond or coconut milk. The Greek yogurt has a bunch too.  Or eggs?  Arnica is both a cream and a pill - but make sure you clear anything topical or any supplements with your physician first. 

  • MorningGlory27
    MorningGlory27 Member Posts: 10
    edited January 2015
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    Thanks SpecialK, I actually had my follow up today, one drain came out, this last one is still over 20ml a day so they want me to keep it in until it goes below 20ml a day constantly for a few days. I am flying to DC for the weekend and will be out more so I am trying to find ways to hide the "granade" my nick name for it;-) I did read about the red breast syndrome and I think that may be what I have, according to the BS it is not as red as it was. I don't know, to me it's the same but I see it every day, she saw it a few days ago. The biggest concern now is that where I have the ischemia, the skin under it and around it has not been adhering to the alloderm. Not much can be done about it at this time, I have to go back in a week to see if it improves, I couldn't get a strait answer out of him as far as what if it doesn't adhere but I am guessing that would involve surgery:-( Guess what my breakfast was lol, chocolate flavored low fat greek yogurt:-) 80 cal and 12g protein. Lunch was a protein bar with 20g and I'll have turkey breast with broccoli for dinner.

  • MorningGlory27
    MorningGlory27 Member Posts: 10
    edited January 2015
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    Steph, I just got back from my checkup and they said they have seen much worse ischemia coming back without a scar so they were not alarmed by it at all. Did they give you nitro cream to put on it? I use that every morning and night, I don't see much change, I would wait if I were you. I'm the kind of person who never gives up unless I absolutely have to. The less scar I see the happier I'll be. My PS said it could take 8 weeks for it to heal. I wish there was some miracle pill that could accelerate healing. Good luck with your surgery, I hope all goes well for you.

  • Captroynsteph1
    Captroynsteph1 Member Posts: 5
    edited January 2015
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    Hi Morning Glory! Just wanted to see how things were going. Are you starting to see improvement? My surgery didn't go exactly as planned. Apparently my anatomy is different from normal and the TDAP wasn't an option. I ended up with a LAT flap covered with a skin graft. A bit more of a recovery, still have some swelling, but should be able to start filling my TE next week. Just thinking about you. Have a great day!

  • MorningGlory27
    MorningGlory27 Member Posts: 10
    edited January 2015
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    Hi Steph, I'm sorry to hear they couldn't do the TDAP. I hope you heal quickly :-) My ischemia is looking much better. My PS told me to put zink oxide on it every day. All the dark skin peeled off and I have new pink skin in most areas. I have a few deeper spots where I have a scab but I'm sure that will eventually heal as well. I wonder if the pink skin will turn darker where my areola is, if not I will have to do tattoo but thats not a big deal. On my other side I didn't have any issues except the tip of the nipple was black. It felt different from the ischemic area, the skin was rough and crusty. I left it alone, never put anything on it and just the other day the black skin just fell off all in one piece and I have my normal looking nipple showing from underneath. I will be getting my first fill next week as well. I am scared as I still feel tight and the TE feel rock hard. My skin is so sensitive over my TEs that anything touches my skin hurts. Its like sandpaper or having a bad sunburn. I hope that will go away soon. I may ask the PS to wait another week with the fill if it doesn't improve. I am also working 5-6 hours starting today so I'm a little nervous, I hope I can do it;-) Thanks for thinking of me, good luck with the fill!

  • concernedhubbyalan
    concernedhubbyalan Member Posts: 21
    edited January 2015
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    My wife is in the same boat, but is also in terrible pain. Today is 10 days post op, but she STILL has not had a bowel movement.

  • MorningGlory27
    MorningGlory27 Member Posts: 10
    edited January 2015
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    What laxatives is she taking? The pain is normal, some women have to take narcotics for 3-5 weeks around the clock before the pain eases. I am more concerned about her not having a bowel movement. That could lead to serious complications. There is an over the counter glycerin suppositories you can get her that will make her go within 10-20 min. For me it worked in 2 min but the longer she is able to hold it in the more productive it is. I took stool softeners twice a day while I was on narcotics. Is her ischemia black or dark purple?

  • concernedhubbyalan
    concernedhubbyalan Member Posts: 21
    edited January 2015
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    My DW is back in the hospital. She now has a massive infection. Her ischemia is black. The PS wanted to correct it with Dakins solution, but that doesn't look likely now.

  • MorningGlory27
    MorningGlory27 Member Posts: 10
    edited January 2015
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    I'm sorry to hear that. I hope the infection can be treated with antibiotics and she doesn't need further surgery. Sometimes it takes weeks for her skin to heal, other times it has to be cut out. I was given Nitro-Bid ointment to bring blood to the area, it gave me headaches so a week later we started using antibiotic ointment twice a day and switched to zink oxide after the dark skin peeled. If it doesn't improve and insurance covers it, she could ask for hyperbaric oxygen therapy.

  • Captroynsteph1
    Captroynsteph1 Member Posts: 5
    edited February 2015
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    Hi MG. Just wanted to check in to see how you are healing. It feels like it has taken forever but I am pretty much healed. Doing expansion now.

    All the best!

  • MorningGlory27
    MorningGlory27 Member Posts: 10
    edited February 2015
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    Hi Steph, thanks for checking on me:) Mine healed as well, my skin is still pink and part of my areola is now a lighter color. They said the pigmentation may or may not come back. It takes 6-12 months and if it doesn't come back, I have to get it tattooed. Ouch!I am also doing expansions every week, so far I had a 100cc put in twice. The first time I had very little pain but the second time I was in a lot of pain for the first day or two and took Vicodin around the clock. Friday is my next apm and I'm so scared. I may have to reduce the fill to 50cc :( how big is your TE? Mine holds 500cc. I can't wait to be done with them.