Nipple necrosis is a medical condition involving the death of tissue in the nipple-areola complex (NAC), the colored area around the nipple. This tissue death occurs when the nipple does not receive an adequate blood supply. It is a serious complication that can arise, particularly following breast surgery.
What is Nipple Necrosis and Why it Occurs?
Nipple necrosis results from insufficient blood flow, or ischemia, to the nipple and its surrounding areola. When this blood supply is significantly compromised, the cells within the tissue become deprived of oxygen, leading to their death.
This disruption in blood flow can stem from various factors, most commonly complications from breast surgery. Procedures such as breast reduction or breast lift (mastopexy) involve manipulating breast tissue and repositioning the nipple, which can inadvertently damage or compress the delicate blood vessels supplying the NAC. Other contributing factors can include trauma to the breast, severe infections, or underlying health conditions that affect circulation, such as smoking, diabetes, or obesity. In some cases, the issue might be insufficient blood entering the nipple or, more commonly, blood not effectively draining away.
Identifying the Early Signs and Timeline of Onset
Nipple necrosis typically appears within days to weeks following an event like breast surgery, sometimes as early as 24 to 48 hours. Recognizing these initial indicators is important for timely intervention.
One of the earliest and most noticeable signs is a change in the color of the nipple and areola. The affected area may initially appear pale, white, or greyish, signaling a lack of incoming blood. As the condition progresses, the color can deepen to purple, blue, or even black, indicating severe oxygen deprivation and tissue deterioration. Changes in skin texture are also common; the skin might become dry, shriveled, or resemble a scab.
Patients may also experience altered sensation in the nipple and areola, ranging from numbness or tingling to a complete loss of feeling. This occurs due to damage to the nerve supply. Blistering can also be an early sign, potentially rupturing and leaving open wounds. A nipple that is struggling with blood supply may feel cool to the touch.
Progression and When to Seek Medical Attention
If unaddressed, nipple necrosis can progress, leading to further deterioration of the nipple-areola complex. The discoloration will typically worsen, with the nipple becoming completely black, hard, and shrunken as the tissue dies entirely. Over time, the necrotic tissue may separate from the healthy tissue.
Contact a healthcare professional immediately upon noticing any of the early signs, such as changes in color, sensation, or texture of the nipple and areola. Prompt medical consultation is advised if symptoms worsen, or if there is persistent or increasing pain. Early detection and intervention can prevent further tissue damage and improve outcomes, sometimes allowing for salvage of the nipple-areola complex.