NAC perfusion issues are managed differently from skin elsewhere — we don't debride early. We often leave them alone for a long time, because in this part of the body it's almost never full thickness. The eschar lifts off and heals nicely underneath.
Two great questions packed into one comment, both of which I get asked a lot. Let's walk through them.
The short answers: yes, surgeons handle their own wound complications, and NAC perfusion problems are managed very differently from wound issues elsewhere on the body. Here's the longer version.
Yes — surgeons are wound-care experts. Pretty much every surgeon manages the wound complications associated with the surgeries they do.
If you have a wound issue after a tummy tuck, breast reduction, breast lift, or any other plastic surgery procedure with me — I take care of it. I don't hand you off to someone else. That's what surgeons are trained to do.
Plastic surgeons have a slightly broader wound-care role than most other specialties because we do two things:
If a general surgeon, vascular surgeon, or orthopedic surgeon ends up with a wound that needs coverage — meaning the wound is too big to close primarily and needs a reconstructive solution — they may consult plastic surgery for help with that piece. We come in, do the coverage, and hand it back to them.
Some general surgeons do their own skin grafts; others call us. Either is fine. The point is that plastic surgeons are the people called when wound coverage gets complicated — but managing the wound day-to-day is normally handled by the operating surgeon.
Wound care clinics are a separate thing, and the question often comes up because patients see them and assume that's where surgical wounds get sent.
Who staffs a wound care clinic?
Who do they actually see?
The vast majority of wound clinic patients are non-surgical — patients with:
You do occasionally see surgical patients there — but typically not because we (the operating surgeon) need help managing the wound. Surgical patients usually end up at a wound clinic because:
It's a logistical resource, not a "we couldn't handle this" referral.
I worked at Kaiser for a few years and staffed the wound clinic there — and that location did have plastic surgeons rotating through. But that's not always the case. Plastic surgeons are valuable in wound clinics specifically because we can do both management and coverage — but lots of wound clinics function fine without one.
So yes: I always manage my own wounds. And honestly, anyone who isn't willing to manage the wound complications of their own surgical patients is a flag worth noting.
This is a different conversation, because the nipple-areola complex (NAC) doesn't behave like skin elsewhere on the body when it has trouble.
After a breast lift or breast reduction, the nipple has to be repositioned, and its blood supply has to keep up. Sometimes the blood supply gets stressed and the NAC starts to look concerning — dusky, dark, blistered, or scabby.
In the rest of the body, when skin has perfusion issues, we tend to debride (cut away) the dead tissue early so we can manage the wound underneath cleanly.
With the NAC, we do the opposite. We mostly leave it alone.
There are a few reasons for this counterintuitive approach:
When the NAC has problems with blood supply, it's almost never full thickness. The deeper layers of skin and the underlying tissue are typically fine. What looks scary on the surface is usually just the top layer misbehaving.
If you wait it out:
The NAC is a perfectly round structure. If you debride too early — before you really know how much tissue is going to demarcate — you risk:
Patience here genuinely produces better outcomes.
This is the part that surprises patients (and sometimes other clinicians): with NAC perfusion issues in a non-implant patient, we often don't need to do anything. No special dressings. No packing. No daily debridement. Just observation, gentle cleansing, and time.
I want to be clear about one important caveat: I feel differently when there's an implant involved, especially in a reconstruction patient.
When the NAC has perfusion issues and there's an implant directly underneath:
This is also why I emphasize OR techniques that protect against this kind of complication in the first place — Keller Funnel, NAC shields, irrigation protocols, etc. The best management of an NAC complication is preventing one in the first place.
The watch-and-wait approach is most appropriate for:
These patients overwhelmingly do best when we don't panic and don't debride early.
If you're a patient and you develop a wound after surgery — or your NAC starts to look concerning after a lift or reduction — here's what I want you to take from this:
Surgeons take care of their own wound complications. Wound clinics primarily exist for non-surgical wounds — diabetic ulcers, venous insufficiency, pressure injuries — and as logistical support for patients who can't do their own dressing changes. Plastic surgeons are uniquely positioned to manage wounds and provide coverage with flaps and skin grafts when needed.
NAC perfusion issues are managed very differently from wounds elsewhere on the body. In non-implant patients, the best medicine is usually time and patience — almost all of these issues are superficial, the eschar lifts off on its own, and aggressive early intervention causes more harm than good. In implant patients, especially reconstruction patients, the calculus shifts and we get more aggressive.
Either way: call your surgeon, not your aesthetician. This is exactly the kind of post-op concern that benefits from someone who understands the surgery you actually had.