5 months post op question

[Ride09]

In two weeks I will be 5 months post-op and I am still very concerned with my left side. The center of the nipple feels like it has attached itself to some deep underlying tissue and whenever I flex it basically pulls it in the center to the point where the nipple is folded in on itself completely. Could this be a crater defect? Or is it possible that the scar tissue is causing this and it may still go away over time? And also, if you have heard of anything like this after surgery, what methods could be used to correct it?

i will try and post pictures soon

[Litlriki]

Thanks for posting the photos.  It's a little difficult to tell from your photos whether or not there's a crater deformity due to a paucity of tissue under the nipple-areola, or if the problem (which appears to be mostly a dynamic one) is due to tethering of the superficial tissue to the deeper tissue.  I encourage my patients to massage the chest post-operatively to avoid tethering of this nature, and I have rarely had to deal with this sort of problem as a result.  If the issue is indeed due to tethering, you may be able to gain improvement with massage, though at 5 months, you may be fighting some tough scar tissue.  Before you do anything, it's probably best for you to see your surgeon and get his or her opinion.

Rick Silverman

[Ride09]

Thanks for the reply Dr. Silverman...I have been massaging for the past few months pretty vigorously. I started massaging about 5 weeks after surgery. Is it possible a steroid injection might be able to break up the tethering? (assuming that is the problem of course) I last saw my doctor about 2 months ago and expressed my concern but he doesn't seem too concerned with it. I have a check up appointment in a week. Also, what do you mean exactly when you say "dynamic"?

[Litlriki]

My impression is that a steroid injection would not help this.  By dynamic, I mean that from your photo, it looks like the problem isn't so much a problem at rest, but rather only when you flex your muscle.  A crater deformity is more typically the result of over-resection of tissue from under the nipple, and it's noticeable at rest and with motion.

RS

[Ride09]

again, thank you so much for your response Dr. Silverman! I guess i'm gonna be looking at some type of revision surgery then.

[DrPensler]

These are always difficult to respond to because without knowledge of what was done at surgery its next to impossible  postulate the exact cause.If things are getting better conservative therapy would be indicated. Some cases of a deep scar pulling the tissue while flexing may be helped with steroid injections while some cases require cutting the bands of scar that cause the deformation.

[Ride09]

Thank you Dr. Pensler. I was looking for pretty much what you just answered for me, whether it was still "possible" to correct itself or not. I've read about a few cases where it took almost a year for something like that to fix itself. I'm going back to my surgeon on Wednesday so hopefully he can do something to help.

I've brought this issue up to him every time I went for a check up and he continues to tell me it will resolve itself so we'll see what he says this week.

[Dr. Elliot Jacobs]

It appears that you have inadequate support under the nipple plus possible tethering or attachment of the nipples to the underlying tissues.

IMHO, steroid injections could make things worse. 

In some revisions that I have performed, the best answer was to surgically release any tethering and then advance some fat flaps to fill in any depression and to create a barrier of normal tissue so that the tethering does not recur.  In essence, the fat flaps provide a platform for stabilization of the nipple.

Dr Jacobs