Dissolvable sutures with synmastia repair?

Question

I had my second synmastia repair with downsize (450 HP to 325 HP) this past Thursday and my surgeon uses the internal sutures that dissolve in 6 months and says the scar tissue acts as a glue to hold the repair permanently after they've dissolved. Is it true that scar tissue can act like a glue to hold the repair together? I did not have any Strattice or any other kind of matrix added to the repair. Am I right to have concerns about the use of temporary sutures for such a complicated repair?

Tom J. Pousti, MD · Answer

I am sorry to hear about the complication you have experienced.   Successful correction of symmastia,  in my opinion  does require some experience;  I would suggest that you do your due diligence when it comes to selecting your surgeon for  this type of revisionary breast surgery.  Ask to see lots of examples of his/her work helping patients in your situation. In my practice, having used a variety of “techniques” for correction of symmastia, I find that the most reliable technique involves capsulorrhaphy ( internal suture repair of the breast implant pockets along the cleavage area).  In the past, I preferred the use of permanent suture; more recently, I have had good success with the use of longer-lasting absorbable suture. Sometimes, the use of acellular dermal matrix ( and more recently biosynthetic “mesh") may be helpful also, in some cases where the tissues are very thin. Often, it is necessary to “open” the breast implant pocket laterally (outer breast fold) to allow for positioning of the implant centrally behind the breast mound. This maneuver may also decrease the amount of implant pressure against the medial suture line.  These maneuvers also serve to better position the nipple/areola complexes, centered on the breast mounds. Sometimes, the use of a larger breast implant is possible, once the breast implant pocket adjustments have been made but patients should remember that the first priority is safety and prevention of recurrence of the breast implant malposition problem. You may find the attached link (dedicated to symmastia corrective surgery) helpful to you as you learn more about the options available.Best wishes.

Robert Whitfield, MD · Answer

The scar or new capsule formation is the issue in this technique.  bE patient and follow your post op instructions!In breast augmentation I have chosen to spend time reviewing
photographs with patients to fully understand their expectation of size and
shape.  Many times this simply raises
more questions.  I will make measurements
and use the implant guides to allow the patient to understand exactly the sizes
that are reasonable for their body type and measurements.

Please find an experienced Board Certified Plastic Surgeon
and member of the Aesthetic Society using the Smart Beauty Guide.  These Plastic Surgeons can guide you on all
aspects of facial surgery, breast augmentation and body procedures including
tummy tucks or mommy makeovers!

Prashant Murugkar, MD · Answer

dearestqwertyI agree with your Plastic Surgeons belief that over time the scar tissue that is laid down around dissolving stitches is strong enough to resist day to day deforming forces.Whether the forces imposed by your breast implants will be resisted by this scar tissue is a call only your PS can make.hope this helpswarm regardsprashant

Donald Nunn, MD (retired) · Answer

Synmastia does have a tendency to recur.  Hopefully you will not have that problem if the scar tissue does its thing.  If it does not I would consider the strattice with the next surgery and a neopectoral pocket.  Good luck.  Donald R. Nunn MD  Atlanta Plastic Surgeon.

William A. Terranova, MD (retired) · Answer

Personally I prefer permanent sutures, but many surgeons use dissolvable sutures (there may be less chance of infection).  There are many plastic surgical procedures that depend on scar tissue to "hold" after the sutures dissolve (face lifts, tummy tucks, breast lifts) and there is no evidence that permanent sutures are any better than dissolvable sutures in these settings.  So I think you can have confidence in your surgeon's choices.

Dissolvable sutures with synmastia repair?

Answers (5)

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