Could it be the Vicryl sutures? I have had previous surgeries w/o complications and monocryl was used.

I'm sorry you have had this difficulty, and certainly wound
healing problems can lead to understandable retrospective analysis as to where
things might have gone wrong.

If you were a smoker, then this would be the first and most serious
culprit--impaired circulation from nicotine vasoconstriction can lead to wound
breakdown, even in cases where the patient is exposed only to second-hand
smoke. But let's assume no tobacco or nicotine products are implicated.

Suture material choices can have an impact on wound healing as well.

Vicryl sutures (made by Ethicon) are made of polyglactin 910, which is a
copolymer of 90%glycolide (polyglycolic acid) and 10% L-lactide.These are braided,
absorbable sutures that retain 75% of their original strength at 14 days, and
25% at 28 days.

Monocryl sutures (also made by Ethicon), monofilament synthetic absorbable
surgical sutures prepared from a copolymer of glycolide and
epsilon-caprolactone. These monofiliment sutures retain
50-60% of their original tensile strength at one week, and 20-30% at 2 weeks.

As you can see, Vicryl not only stays around a bit longer, it's construction is
braided vs. monofilament. This is important because skin sutures will
unavoidably go right through pores, hair follicles, and sweat glands, all of
which contain skin bacteria (yes, even after surgical prep and antibiotics).
The interstices within Vicryl braids can indeed provide a "safe
harbor" for bacteria, causing tiny pus pockets that many surgeons call
"Vicryl reactions." I've written an article on this topic you might
wish to read by clicking on the web reference link below.

These so-called Vicryl "reactions" are not allergic at all, but
simply represent "normal" skin bacteria causing stitch abscesses that
can lead to wound breakdown. Once it starts, what you are experiencing can
often result. Many patients simply would view this and see
"infection," but it really starts with normal skin flora causing
these tiny stitch abscesses that lead to eventual wound breakdown.

Believe me, this CAN happen with monofilament sutures, but it is much less
likely, and why many surgeons, myself included, have switched to all
monofilament sutures for skin closure. It's not the "fault" of the
suture, since those bacteria are present in the environment where the sutures
are placed, and the warm, moist, braids are the perfect place for those
bacteria to multiply/ BTW, the usual antibiotics used do not kill these
"normal" skin bacteria, only nastier ones that can cause even worse
problems.

So, yes, I think suture choice can play a role in some of these problems. It's
not something every surgeon will agree with, but I simply deal in facts. While
suture choice cannot be assumed to be the entire cause of these wound issues,
every aspect of every choice and step in the healing process can be examined
critically. I think your question is wise, and I would suggest that Vicryl not
be used for further surgery on your breasts. That won't guarantee success, but
it WILL eliminate one potential negative aspect. Don't be too hard on your
surgeon; Vicryl is used by lots of surgeons for lots of skin closures that heal
just fine.

I just happen to believe that Vicryl "reactions" don't really exist.
Click on the web reference link below for more information. Good luck with your
healing and best wishes! Dr. Tholen

Hi Tammy,I am sorry you are having problems like this.  It sounds like you are receiving good care for a difficult setback.  Vicryl sutures last up to six months, and can cause an incision to spit or come apart.  There are other reasons this can happen, but yes, vicryl could be a contributing factor.  You may never know for sure.  Keep your surgeon in the loop!  I hope your heal up real soon, and this will be behind you.

Sorry you have to go through this complication.  Fortunately, problems like this are fairly uncommon!  It is of course possible that the suture material could be involved but more likely was a problem with the blood supply to the skin.  The area where you developed some breakdown of the skin is the most common site when this happens.  It is unusual when downsizing implants especially but could theoretically still happen.  That being said, without being involved in your case from the start to the current point, it is really impossible for anyone in this forum to really be able to comment.  It is best to follow closely with your surgeon and discuss the possible cause of this complication since they are intimately involved in your case and invested in your well being/outcome. Good luck!

I'm very sorry to see your difficulty.  However it does seem that your plastic surgeon is using the appropriate methods to correct the problem.The loss of skin and skin graft is most likely related to inadequate blood supply rather than Vicryl sutures.  However continue to follow your plastic surgeon for appropriate wound care.  Ultimately I think you will have an acceptable result.