Breast Areola Incisions and Steri Strips?

Question

Hi Doctors - what do you think of NOT using steri strips on areola incisions for breast implant surgery? One of my consultations said 'No steri strips, but absorbable sutures for both to stitch internal layers and to close under the skin (I don't do well with permanent sutures)", but other consultations said to put steri strips on the incisions. Any potential problems by NOT having them? Pros and cons of NOT having them? I am worry about the tension and the ability to hold the edges together.

Richard Zienowicz, MD · Answer

Transaxillary approach is through the arm-pit. It is the most sophisticated technique. Armpit incision is a wonderful scar-free option for breast augmentation. Silicone or saline implants can absolutely be inserted through the arm-pit, don't let anyone tell you that is not an option. There is really no reason for an incision under the breast or through the nipple. The scarring under the armpit is minimal, there is minimal bleeding or bruising. Review the attached video. Don't let doctors not comfortable with the approach talk you out of it. It does not make sense to put scar tissue on a breast. Transaxillary is the standard in Asia and the UK and the results are completely natural. Patients are so happy not having to deal with any types of incision or scarring on the breast with little to no pain after surgery.

Tom J. Pousti, MD · Answer

As you will see, there will be many different opinions about the use of tape on incision lines. I would agree with those opinions  stated that the steri strips are not the most important factor in determining the final appearance of the incision lines. Careful deep and dermal skin closure  is critical.

	No, I do not think there will be any “potential problems” by not using steri strips.

	Best wishes.

Tiffany McCormack, MD · Answer

I have gone back and forth on this many times. I think an advantage of using steri strips is that it helps keep the scar from raising post operatively. I do not depend on them to hold the wound together and will only use them like a strip of tape over the top rather than crisscrossing horizontally across the scar. I like to minimize how much skin is covered by them because i have seen patients develop blisters underneath them. Limiting skin coverage and never using an adhesive underneath (such as mastisol or benzoin) seems to decrease the chances of this happening but does not all together eliminate the risk. As an aside, it is sometimes easier for patients to look at their breasts post operatively if the scars/incisions are somewhat covered and I like that they can shower with them on. Another alternative is to use paper tape over the scars after several days to keep them from raising. I know that excellent, tension free closure is the main factor is post operative scarring but even in the best case patients can scar abnormally despite what the surgeon does. Hope that helps!

Robert L. Kraft, MD, FACS · Answer

I agree with Dr. Seckel; steristrips or internal sutures are not a substitute for a fine wound closure.  I understand that you had an issue with permanent sutures but 1/skin sutures are not permanent and are removed by the plastic surgeon 2/it is important to ascertain what suture material you reacted to and how.  Some patients do, in fact, have problems associated with certain braided suture materials but these would not be used in the skin closure.

John Whitt, MD (retired) · Answer

I always use steristrips with periareolar wound closures when using a subcuticular suture which I typically do. I think that the steristrips offer a bit of insurance against widening of the scar and simply feel that these wounds heal better and with better scars when steri-strips are employed.

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question.

	A careful deep skin closure with absorbable sutures is the most important factor in achieving a good Areola scar after Breast Implants.

	I would not rely on steri strips to hold the skin edges properly closed.

	They can help prevent retraction of the very surface of the wound.

	I have over the years generally stopped using steri strips and rely on a good skin closure. The problem is that on occasion the steri strip can hold moisture under the tape and trap the moisture against the skin. If this happens, on some occasions, the surface skin cells become macerated (liquified) and the scar can be made worse.

	Rely on your surgeon to do what is best for you.

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