Why are my nipples black? I don't feel like I'm being given straight answers at the VA? (Photos)

Thanks for your questions and submitting your concerns. With free nipple grafts, there can be some variability of how quickly the grafts "take". The pinker areas likely took or revascularized quicker, then the central areas. The black areas might just be superficial, and when that sloughs off, there could be enough salvage of the central part of the grafts. I would discuss with your plastic surgeon - it usually requires some good local wound care and the central parts of the grafts can be salvaged. 

This is not unusual following Free nipple graft surgery. The nipple is thinned less than the areola and often it is the nipple area that takes the longest to heal. The incisions will improve but you need postop support regarding the scars. Keep in touch with your PS who can advise you.

Free nipple grafts can take at varying rates from side to side, and portions of the areola may take better than the central nipple itself. Part of the reason for this may be that the nipple tissue is bulkier and skin grafts (which is what a free nipple graft is) often have to be thin to optimize the take. We don't normally thin/debulk the actual nipple so it is not unheard of that the areola takes well but the central nipple has partial tissue loss. This will usually recover to heal with a reasonable appearing central area that is a different color from the rest of the areola, but projection of the nipple might be altered by the grafting process itself. As for your incisions, sometimes the pattern is slightly different based on the size/shape and hang of the breasts (people are not symmetric naturally), but I don't really see the severe asymmetry of incisions that you are describing. If you are frustrated with the answers you get from your surgeon, consider asking for a second opinion.

You mentioned that you had a FNG dressing removed after surgery.  I presume you mean that you had a free nipple graft, and the bolster dressing was used in the postoperative period.  When a patient has a free nipple graft, the nipple and areola have to re-establish blood supply from the tissues where the graft is placed.  Occasionally, there will be partial loss of the skin graft as the new circulation is established, and this will typically manifest as a purplish or blackened area of skin.
The blackened area will typically separate from the underlying tissues where there is healthy blood supply.  In your case, because the blackened areas are small, you should see healing of the residual open wound quickly from the wound base or from the peripheral edges of the open area.  You might see scar tissue or flattening of the central nipple when this occurs.
3 weeks is in fact early in the course of postoperative healing.  Things will settle in as the swelling improves, so reassurance is in order.  Open communication with your plastic surgical care team is important!
Best of luck in your postoperative healing!

Hi thank you for your question. If you have had a free nipple graft the nipple and areola need to develop a new blood supply from the underlying breast (as they were completely removed from the breast to be repositioned). From your pictures, it appears the areolae (the flat discs) have received a new blood supply as they are pink. The nipple is thicker and it is harder for the new blood supply to fully nourish this which means part of it may necrose and be lost. If this happens it will go black and scab over which is what your photos suggest has happened.
Once the scab separates you should be able to see if any of the nipple has survived.
Best wishes.

 Your plastic surgeon will always be your best resource when it comes to  providing you with an accurate diagnosis and/or meaningful reassurance.  Generally, "black nipples" indicate a problem with blood supply to the involved area (leading to tissue necrosis).  In other words, it is most likely that there has been a problem with arterial inflow or venous outflow to the nipple.   Typically, the dark tissue will "lift off" over the course of the next several weeks.   How much tissue was involved with the process will become clear at that point. Best wishes.