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

Table 1: Baseline characteristics and medical history
Characteristic/history Absorbable barbed suture (n = 20) Permanent suture (n = 12)
Age, years, mean (range) 42.6 (24-66) 40.1 (20-71)
2
BMI, kg/m , mean (range) 22.9 (18.5-28.5) 24.4 (19.0-34.7)
Hypertension, n (%) 2 (10.0) 1 (8.3)
Current smoker, n (%) 4 (20.0) 3 (25.0)
Diabetes, n (%) 1 (5.0) 1 (8.3)
Any other relevant medical history, n (%)* 6 (30.0) 6 (50.0)
Previous breast surgery, n (%) † 6 (30.0) 2 (16.7)
*Patients in the barbed suture group also had other relevant medical history that included a history of: leukopenia (1); kidney disease
(1); rheumatoid arthritis (1); heavy scars (2); lupus and fibromyalgia (1); and high blood pressure, steroid use, blood clots, and Hodgkin
Lymphoma (1); patients in the smooth suture group also had a history of: allergies and exercise-induced asthma (1); hypercholesterolemia,
cough and asthma (1); breast cancer (1); cough and in-utero fibroids (1); medullary sponge kidney (1); and heart and gastrointestinal
disease (1).†Patients in the barbed suture group had previously undergone bilateral mastopexy (1), breast reduction (3), lumpectomy (1)
and biopsy (1); patients in the smooth suture group had previously undergone lumpectomy and axillary node dissection (1) and excision of
a benign cyst

Table 2: Surgical record
Permanent suture
Surgical record Absorbable barbed suture (n = 20)
(n = 12)
Mastopexy only, n (%) 9 (45.0) 3 (25.0)
Mastopexy in conjunction with other aesthetic procedures, n (%)* 11 (55.0) 9 (75.0)
Abdominoplasty 6 (30.0) 5 (41.7)
Blepharoplasty 3 (15.0) 1 (8.3)
Correction of inverted nipple, bilateral 1 (5.0) 0 (0)
Hernia repair 2 (10.0) 0 (0)
Liposuction † 2 (20) 1 (10)
Filler to lips and/or nasolabial folds 2 (20) 0 (0)
Upper abdominal lift 0 (0) 1 (8.3)
Mastopexy technique, n (%)
Circumvertical 20 (100) 12 (100)
†
*Some patients had multiple additional procedures. Patients in the barbed suture group had power-assisted
lipoplasty of the hips, abdomen and thighs (1) and bilateral anterior axillary liposuction (1). The patient in the
smooth suture group had liposuction of the neck
in conjunction with various other aesthetic surgical No major or minor complications were reported for any
procedures [Table 2]. Of these, abdominoplasty was patient who underwent mastopexy closure using the
the most common procedure; it was performed in 30% absorbable barbed suture [Table 4]. In contrast, 2 of
of procedures in which the mastopexy incision was the 24 breasts (8.3%) where ePTFE suture was used
closed with absorbable barbed suture, and in 41.7% of had complications. In one case, complications included
procedures in which ePTFE sutures were used. wound dehiscence and infection; this patient had a
history of breast cancer. In a second case, complications
Follow-up photos used for the assessment of areola were limited to wound dehiscence and fat necrosis; this
size were taken a mean of 11.2 months postoperatively. patient had a history of hypertension and diabetes.
Mean follow-up times were similar for both cohorts: 10.7
and 12.0 months, respectively [Table 3]. Among patients DISCUSSION
in the ePTFE suture group, areola size for both breasts
increased a mean of 0.49 ± 0.57 cm from a baseline We believe the unique property of the barbed suture
mean of 3.90 ± 0.18 cm (P = 0.011), representing a
12.5% increase from baseline. allows redistribution of tension forces throughout the
entire length of the closure, and is particularly effective
Using absorbable barbed suture, areola size increased for round closures under circumferential tension. Smooth
a mean of 0.20 ± 0.70 cm from a baseline mean of 4.11 sutures, whether permanent or absorbable, allow tissues
± 0.24 cm (P = 0.236), representing a 4.9% increase to slide along the length of the suture and “bunch up”
from baseline. The increase in areola size was a mean of similar to the way a shower curtain slides unevenly along
0.29 ± 0.16 cm less for patients in the absorbable barbed its rod. Furthermore, we have found that long-acting
suture group; however, the difference between groups absorbable sutures provide enough strength to allow
in the change from baseline areola size did not reach quality tension-free healing to occur without leaving
statistical significance (P = 0.092, based on ANOVA). permanent foreign body material beneath thin areolar
Plastic and Aesthetic Research ¦ Volume 3 ¦ September 20, 2016 299