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Rosen et al. Barbed vs. smooth suture for periareolar closure

INTRODUCTION technique can be found at https://www.youtube.com/
watch?v=IHxKsC4S85c. We observed a satisfactory
According to the American Society of Plastic Surgeons, preservation of areolar size post op and had no knot-
approximately 90,000 breast lifts were performed in the related infections. No herniated or distorted areolas
United States in 2013. Mastopexy closure techniques were noted and no palpability or visibility of the suture
[1]
have evolved over the past decade to help limit scarring was encountered. In addition, the long-term potential
associated with the classic inverted-T technique, nidus for infection was eliminated. Previous studies have
replacing it with Concentric (Donut) and circumvertical confirmed the cost effectiveness, safety and efficacy of
techniques with or without short horizontal scars. [2-4] using barbed suture. [8,9]
Even the concept of a simple purse-string periareolar
closure, first described by Benelli, evolved to the more We published our work with absorbable bidirectional
[2]
popular interlocking (pinwheel) purse-string technique, barbed suture for wound closure in abdominoplasty
as described by Hammond et al., using permanent and body contouring procedures. [10,11] Shortly after,
[5]
expanded polytetrafluoroethylene (ePTFE, GORE- we expanded its application to include our mastopexy
TEX , W. L. Gore, Phoenix, AZ) suture for the deep closures. We undertook a formal chart review to test
®
layer. Franco et al. reaffirmed the safety and reliability our hypothesis that the absorbable barbed suture, when
[6]
of the interlocking purse-string periareolar closure applied using an interlocking purse-string technique, was
using ePTFE, by evaluating a retrospective series of 50 effective in limiting the spread of the areola size post
patients who underwent augmentation mastopexy. They mastopexy. Swanson found photometric analysis of
[12]
found a complication rate of 6% specifically associated outcomes to be effective in assessing outcomes of breast
with infected ePTFE requiring removal of this permanent surgery and we decided to apply similar assessment
foreign body. Other complications that we encountered tools to our study population.
with ePTFE in our work prior to 2008 included wound
dehiscence, knot extrusion, suture palpability, fat METHODS
necrosis, and areolar widening. Non-interlocking purse-
string techniques using ePTFE prior to 2008 were We conducted a 10-year retrospective chart review
occasionally complicated by herniation of the areola of consecutive patients (71 patients/142 breasts) who
secondary to a “cerclage” effect with spread of the areola underwent mastopexy, either alone or in conjunction with
beyond the boundaries of the initial suture placement. other aesthetic breast and body procedures. From 2003
to 2008, all mastopexy closures (30 patients/60 breasts)
In 2008, with the introduction of absorbable barbed at our center were performed using permanent ePTFE
suture (Quill™ Knotless Tissue Closure Device, Surgical sutures for the subdermal layer and smooth absorbable
Specialties Corporation , Wyomissing, PA) we began Monocryl suture for deep dermal and subcuticular
®
using this new suture technology instead of ePTFE sutures closure. From 2008 to 2013, mastopexy closures (41
for interlocking purse-string periareolar closure in our patients/82 breasts) were performed exclusively with
mastopexy, reduction mammoplasty, and augmentation absorbable barbed suture. We used bidirectional PDO™
mastopexy patient population. Demonstration of this (polydioxanone) for the deep layer and Monoderm™
[7]

Midpoint

Figure 1: Interlocking purse string suture technique (deep layer Figure 2: The periareolar wound prior to suture deployment is
with 2-0 PDO Quill) marked in divided quadrants
Plastic and Aesthetic Research ¦ Volume 3 ¦ September 20, 2016 297