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

Figure 3: Intra operative photo with interlocking purse-string barbed Figure 4: The final intra operative appearance of the 2-layer
suture prior to cinching (outlined diagrammatically in Figure 2 above). absorbable barbed suture closure as described
(PGA-PCL) for subcuticular layer. Monoderm™ retains and complications. Both pre- and postoperative photos
62% of its original tensile strength at 7 days, and 27% at were taken with Mirror Image Software (Canfield
14 days, with absorption essentially complete within 90- Scientific Corp, Fairfield, NJ). Surgical areola marker
120 days, while the longer-term PDO™ retains 50-80% size was obtained from operative report review. Follow-
of its original tensile strength at 4 weeks, with absorption up assessments were based on photos taken between 6
essentially complete within 180 days. [13,14] and 24 months postoperatively, and postoperative areola
sizes were measured using free digital photo software
We selected a patient population specifically to limit (GNU Image Manipulation Program/www.gimp.org).
variables related to skin tension forces. We, therefore, Areolar width and height measurements were completed
excluded reduction mammoplasty and augmentation using the GIMP software.
mastopexy and focused solely on patients undergoing
mastopexy alone. The study population was further The primary outcome was the change from baseline
limited to patients with postoperative photographs areolar template size used and the photometrically
between 6 months and 24 months after the mastopexy measured postoperative areola size. T-test statistics
to minimize variables associated with aging. were used to compare within group pre-operative areola
size with postoperative areola size. Analysis of variance
The final analysis was performed on 20 eligible patients (ANOVA) was used to compare change from baseline
(40 breasts) in whom closures were performed using scores between groups, using XLSTAT software,
absorbable barbed suture exclusively. Since no previous Version 2014.5.01. This later test was considered to be
reports of areolar spread rates have been published, the preferred test to assess changes from baseline in
for comparison purposes, we assessed 12 eligible studies with a non-randomized design. The incidence
[15]
patients (24 breasts) in whom mastopexy closures were of complications was considered a secondary outcome.
performed with ePTFE/Monocryl. The primary author
performed all surgeries using the same circumvertical RESULTS
technique at the same surgical center. Diagrammatic
[4]
representation of interlocking purse string technique is The 32 patients assessed had a mean age of 41.6 years,
demonstrated in [Figure 1]. Intraoperative photos are and mean BMI of 23.5 kg/m . Patients whose mastopexy
2
shown below depicting the periareolar wound, prior to incisions were closed with absorbable barbed sutures
suture deployment [Figure 2], after suture placement were similar in both age and mean BMI to those closed
[Figure 3], and after final closure [Figure 4]. with permanent sutures [Table 1]. The two groups were
also similar in the incidence of hypertension, diabetes
In the permanent suture group, a ligature was secured and in the percentage that were current smokers. Many
with a surgeons knot at the T-zone. Cinching of the suture (12/32, 37.5%) had a history of other relevant medical
was performed to the desired areolar size in both groups. conditions. More subjects in the barbed suture closure
Data were compiled for patient demographics [age, group had undergone previous breast surgeries: 6/20,
body mass index (BMI)], medical history (hypertension, 30.0% vs. 2/12, 16.7% in the ePTFE group.
smoking status, diabetes, previous breast surgery),
surgical record (technique used, additional procedures) In 62.5% of cases (20/32), mastopexy was performed
298 Plastic and Aesthetic Research ¦ Volume 3 ¦ September 20, 2016