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Tubular Breast with Mastoplexy: is a Permanent Purse String Suture Needed?

asked 2 years ago by azhiker in tempe
Latest answer by Tom J. Pousti, MD
Question viewed 5,436 times
Tags: breasts, sutures, tuberous

I have asymmetrical tubular breast and have been told that I need a concentric mastoplexy and augmentation. I have been told by some doctors that they always do a permanent purse string suture to keep the nipple from expanding. Others say that you can always feel this suture and that it is not necessary. I do not want my lover to be able to feel the suture when we are intimate. Is it necessary and what are the risk of not doing it?

18 answers to Tubular Breast with Mastoplexy: is a Permanent Purse String Suture Needed?

Tubular breast correction with mastopexy

It is hard to tell for sure from the side view, but you do not seem to have too much asymmetry. I would stay away from any permanent pursestring suture. In general the periareolar mastopexy which requires a pursestring suture has the risk of release of that suture and delayed deformity around the areola causing radial striations that are difficult to fix. If the asymmetry warrants more than a conservative periareolar reduction I have found that the full mastopexy creates complete... more

Kimberley O'Sullivan, MD
Boston Plastic Surgeon

Tubular breast deformity and mastopexy using purse string technique

As you can see from previous post your particular breast shape presents a difficult reconstructive problem. In my experience periariolar mastopexy with augmentation to reshape and thrust the breast is usually not the answer. If you wish you can go on my site and include your email address and I can send pix of treatment of a similar case.

Barry H. Dolich, MD
Bronx Plastic Surgeon

Tuberous ( Constricted) Breast Correction?

Thank you for the question and picture You have appropriately heard of the downsides of using permanent as well as the downsides of using absorbable sutures. Unfortunately, there is no perfect solution. For “minor” tuberous breasts correction options very. Sometimes it is possible to use breast implants only without an incision around the areola; patients potentially will contain to have a “puffy” areola appearance.In other cases of... more

Tom J. Pousti, MD
San Diego Plastic Surgeon

Tubular Breasts and Permanent Suture

Tubular breast deformity is characterized by a narrow or constricted breast base. The breast tissue is then herniated into a, usually, widened areola. The deformed breast my be paired with a normal breast or a breast with any number of other deformties. The correction involves an augmentation mastopexy. Because of the large expansion of the breast tissue with the implant there is a tremendous amount of stress on the areola. This often results in widening of the areola to a very... more

Christopher L. Hess, MD
Fairfax Plastic Surgeon

www.hessplasticsurgery.com

Circumareolar Mastopexy

Hi there- You are among the very small group of women for whom I believe a circumareolar approach to mastopexy is ideal. One of the major problems with this operation is the spreading of the areola that can occur- the areola gets larger and becomes a larger than preferred focal point on the breasts... Generally patients hate this look. In order to avoid this, it is necessary to use a suture that holds its strength until the new breast shape is stable. There are going to be many differences of o more

Armando Soto, MD
Orlando Plastic Surgeon

www.DrArmandoSoto.com

Control the expansion

I understand your concern. In my opinion a permanent suture will control the shape of your areola much better. A absorbable suture can be used but you must be will to accept the trade-off, a stitch you or your lover can not feel over time versus the possibility of wider areola of the breasts. Consult with several board certified plastic surgeons for an evaluation. Good Luck

Earl Stephenson Jr., MD, DDS
Atlanta Plastic Surgeon

Tubular breasts

Yes, you will most likely need a circumareola control suture for your areola. This can be performed with a soft suture like Gortex which is barely palpable, if at all.

Steven Wallach, MD
Manhattan Plastic Surgeon

Permanent stitch for augmentation mastopexy correction of tuberous breasts

To some degree a lift and augmentation are conflicting operations. In one you are removing skin to create a "lifted" breast and in the other you are placing an implant whihc stretches the skin. If you do not use a permanent suture, you will risk enlargement of the areola. Necessity of the suture is a function of your cosmetic expectations.

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Permanent vs dissolving suture for tubular breast mastopexy

You can tell from the various answers that there are differences of opinion about the use of premanent sutures. You will definitely need a pursestring (Benelli) mastopexy. With permenent sutures, there are actually a couple of issues, one of which is that it can be felt even if it is in a deep layer. Another is that the areolar diameter normally expands and contracts depending on temperature, stimulation, etc; if it is fixed by a permanent stitch, then it has to pooch out like a snoopy dog... more

Richard Baxter, MD
Seattle Plastic Surgeon

Permanent vs absorbable suture for Mastopexy

When doing a periareolar mastopexy like what you need, a long lasting suture is ideal, since it lasts until the scar is strong enough to resist spread. This does not necessarily have to be a permanent suture, however. Permanent sutures have been used for this for a long time. Now, however, there is a suture that is absorbable, but does so over 6 months. This is enough time for the scar to obtain strength enough to resist spreading of the scar without the suture. I would suggest you talk... more

Robert T. Buchanan, MD
Highlands Plastic Surgeon

Tubular breasts require internal breast lift.

Hi. You have extremely difficult anatomy in your right breast which requires very skilfull reconstruction with an internal breast lift. In your particular case, you don't need permanent purse string suture because the areolas are not bulging out too much.

George J. Beraka, MD
Manhattan Plastic Surgeon

Correction of a true tuberous/tubular breast requires experience

On the whole surgeons don't see many individuals with a tuberous, yes tuberous and not tubular, breast shape. After many years in my own practice I can imagine the disappointment a cosmetic surgeon might experience when expecting an 'augmentation' of an A-cup breast, and being confronted by such a challenge. Much has been written by myself and others on this site and you may wish to search a bit to see what has been recommended. The term tuberous was taken from the word tuber or potato like... more

Peter E. Johnson, MD
Chicago Plastic Surgeon

Permanent suture in tubular breast surgery

In the correction of the tuberous or constricted breast I would use a suture that is placed under in the deeper skin called the dermis and its job is to keep the diameter of the areola from spreading too large. I tell my patients that if this suture bothers them after at least 6 months I can remove it. If you remove it there is a chance the areola will widen but less so at that time after you have had the chance to heal more. Having said this I have had only... more

Michael C. Edwards, MD
Las Vegas Plastic Surgeon

Tubular breast deformity

You appear to have asymmetric tubular or constricted breast deformity. There are a number of options that should be reviewed by your surgeon.Not all such deformity needs a concentric or periareolar lift. If you do, then a permanent purse-string suture is an option but it depends on what the risk of areolar expansion is vs. palpability of the suture. Many of these permanent sutures pull thought the soft tissues over time and the areaola expands slowly so another option is using a... more

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Tubulat breasts

There is a permanent suture I use to prevent the areola from speading out like a pancake later. I have never heard of a patient saying this was palpable becuase I place it in the deep layer of the skin.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

Concentric Breast Lift (Mastopexy) and Use of a Permanent suture

Your question touches on two issues; The Tuberous Breasts and the Concentric / Periareolar Matopexy. From the picture you provided you have a severe case of breast constriction (on the right) with significant asymmetry. Its correction would require a periareolar incision, radial releasing incisions to break the constriction, correction of the areolar herniation and the use of sizers to pick the implant which would most closely match the left breast. Personally, I would love to defer any... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

Tubular Breast Deformity

In most cases, when performing surgery for tubular breast deformity, a permanent suture is needed to give the best result. However, every patient is different and your surgeon may feel that a temporary surture is better. This is something that you should discuss with your surgeon. Good luck.

David Shafer, MD
New York Plastic Surgeon

Sutures following tubular breast correction

You will need some type of suture around the areola at the time of surgery. The choice of permanent versus absorbable suture depends upon your surgeon's preference and experience. If you will be having a very large implant placed, a permanent suture might be a better option to prevent spread of the areola. However, even with a permanent suture, it is generally not that palpable. The shape of your breasts will be much better after surgery, and that is what you and your... more