Worrying about a scabbing nipple? After a mastectomy, it can be difficult to know which changes to the breast and nipple are a normal part of the healing process and when they’re something to talk to your doctor or breast surgeon about. Seeing your nipple scab over after a mastectomy can be scary. One MyBCTeam member wrote “I was freaked out, thought my nipple was dying, but the plastic surgeon assured me it was normal and it ended up healing nicely.”

After a nipple-sparing mastectomy (NSM), some nipple scabbing is normal. The nipples get less blood supply during surgery, due to the removal of breast tissue (including blood vessels). Below are three things to keep in mind about nipple scabbing after a mastectomy, including potential at-home remedies and signs that it’s time to talk to your doctor.

1. Some Nipple Scabbing and Color Change is Normal

As your body heals after a nipple-sparing mastectomy, it’s normal to have some scabs on your nipple and for the nipple to be a different color than usual. One MyBCTeam shared, “It was pretty gross. Dark purple and scabs. Sent the doctor pictures, and he said it was fine. And it is.”

Changes to the nipple after breast surgery, like scabbing, are usually due to there being less blood flow to the nipple as the tissue behind the nipple is removed during surgery.

Scabbing from a small amount of skin necrosis (skin tissue death) may heal on its own. Even so, it’s still a good idea to tell your doctor or surgical team about your scabs. They may have techniques to promote better healing.

There is no set time it takes scabbing nipples to heal. It could take a few weeks or months for the breast skin to heal. After that, your care team might offer plastic surgery if there’s a large area of necrosis that has not healed on its own.

If your nipples don’t heal well on their own, they may need more dedicated treatment. Ask your doctor about how long the healing process takes and if there are any time points at which you should follow up about lingering scabbing.

2. Nipple Scabbing Can Be a Symptom of Nipple Necrosis

While some nipple scabbing is normal after mastectomy, nipple scabbing that doesn’t heal on its own may be a symptom of nipple necrosis. Nipple necrosis is when the nipple doesn’t get enough blood, causing some of the skin tissue to break down or die. Your doctor can help you determine whether your scabbing is a sign of wound healing or an indication of potential nipple necrosis.

Nipple necrosis can happen after nipple-sparing mastectomy with or without immediate breast reconstruction surgery, such as putting in tissue expanders. Necrosis can also happen anywhere on the breast skin after different procedures.

Of the possible complications associated with NSM, researchers have flagged nipple necrosis (also called nipple-areola complex necrosis or NAC necrosis) as the main concern. It is also one of the most common.

Risk factors for nipple necrosis include:

• Smoking or a history of smoking
• Having radiation therapy before surgery
• Having a larger amount (more than 400 grams) of tissue removed during mastectomy

If you notice signs of necrosis, tell your doctor or surgical team right away. Signs of necrosis include:

• Scabbing
• Red, tender, or swollen skin
• Skin or nipples that look discolored, such as black, dark brown, or dark blue
• Open wounds
• Fevers

If the necrosis is minimal, your surgeon may only need to do a minor surgical procedure to remove the dead tissue and then give you something to take care of the wound at home. If the necrosis is extensive, they may need to remove the nipple (which can potentially be reconstructed later). The sooner treatment is started, the better, so let your doctor know about any signs when you see them.

3. You Can Care for Your Nipples at Home

If your nipple scabbing is minimal and there aren’t signs of more extensive nipple necrosis, you may be able to see your nipples through the healing process at home.

Your surgeon should provide you with information about caring for your breasts and nipples at home after a mastectomy. It’s important to follow all postsurgery care instructions to give yourself and your nipples the best chance at healing.

At-home remedies for scabbing nipples may include basic wound care, such as putting a petroleum jelly (like Vaseline) on your nipple and covering it with gauze to help it heal. The petroleum jelly and gauze should be reapplied after you take a shower. Be sure to note when your surgeon says it’s OK to take a shower after a mastectomy.

Your doctor may also prescribe antibiotics or an antibiotic ointment to treat small amounts of necrosis and prevent infection. One MyBCTeam member wrote, “I have bad scabbing. Very gross-looking. Doctor has me using bacitracin and said that, due to no blood supply, healing will take a while and could possibly lead to some necrosis of nipples that may need treatment later on.”

Ask Questions To Reduce Your Worries

With the many changes breast cancer treatment can bring, it’s completely understandable to be concerned about making sure your nipples are healthy — especially after a nipple-sparing mastectomy in which the goal is to keep your nipples. Although they’re a small piece of you, nipples can be an important part of feeling like yourself.

“Although my doctor said most heal fine, I’m very worried about it. Keeping my nipples has been very important to me throughout this. Something I can actually keep, instead of having to remove,” one MyBCTeam member shared.

Ask your health care team what you can expect about your nipples after a mastectomy. They can help you know when they just need a little care at home and when it’s time to ask for help from your surgical team.

Talk With Others Who Understand

MyBCTeam is the social network for people with breast cancer and their loved ones. On MyBCTeam, more than 64,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.

Have you experienced nipple scabbing after a mastectomy? How long did it last, and what helped you heal? Share your experience in the comments below, or start a conversation by posting on your Activities page.