Breast lift --external sutures or internal only: which do you prefer and why?

Question

Hi there! I am wondering if it's best to have sutures on the inside only with a breast lift, or outer sutures also? Which do you prefer and why? I had a donut incision that healed well with internal stitches only and I'm nervous about surgeons who want outside stitches for a lift and concerned they may not heal well. Would like to know what other surgeons prefer and the reasoning behind this.

Robert Cohen, MD · Answer

I have performed thousands of breast surgeries with all types of issues and skin elasticity, and I have never needed to use external sutures. External sutures run the risk of stitch marks unless they are removed in 6-7 days, but it is helpful to have skin support longer than that.  Although there is nothing "wrong" with external sutures per se, I think a subcuticular (under the skin) closure is a cleaner and more elegant approach, and should be combined with longer lasting deep sutures to keep tension off the wound to minimize scarring.  Hope that helps!

Raymond Goh, MBBS (Hons), FRACS (Plast) · Answer

Hi Hopeforbetter.
There is little indication for the use of external sutures in any breast surgery. External sutures cause can sometimes cut into the skin and leave unsightly cross hatches. The only time when a surgeon may consider using outside stitches is if the patient has had a reaction previously to internal sutures.
Hope this helps.
All the very best.
Dr Ray Goh

Kenneth Hughes, MD · Answer

There have been a great number of techniques that have been utilized through the years for breast lifts with regard to suture techniques, tissue rearrangement, and skin patterns.  The results have less to do with the technique used and more to do with the genius of the surgeon utilizing them.  There is no best technique.  Find a plastic surgeon with ELITE credentials (certified by the American Board of Plastic Surgery, education, experience, training) who performs hundreds of breast lifts each year.  Then look at the plastic surgeon's website before and after photo galleries and read patient reviews.Kenneth Hughes, MD, Board Certified Plastic Surgeon Los Angeles, CA

Jeffrey Ridha, MD · Answer

Almost all forms of breast lift surgery incorporate internal suturing. It is most often in the final or outer layer where there may be variation.  External sutures are typically used only in the final layer buy some surgeons based on their preference. As long as those sutures are removed within a certain period of time, with good technique, similar results would be expected with either method. Best wishes.

William J. Welsh, MD (retired) · Answer

The type of suture used by a surgeon. Depends on many factors: The patient skin type, the procedure used and convenience of both the patient and the surgeon. Most of the time in my practice all sutures are placed under the skin and I purport that is the case with most plastic surgeons. However, sometimes at the completion of a suture line I might notice a small area that doesn't look quite satisfactory and in that case I might place a few skin sutures to enhance the result. The ultimate incisional scar is not usually affected by these sutures as they are removed quickly - they usually serve the purpose in 48 hours. Even sutures under the skin can be problematic for some patient. In the occasional darker skinned patients I have seen post inflammatory pigmentation delineate the suture line under the skin! Each surgeon tries to achieve the best result he can for his/her patients.

Breast lift --external sutures or internal only: which do you prefer and why?

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