Can an extended brachioplasty be done without sutures?

It's not possible to do a brachioplasty without using sutures. You have to use some absorbable sutures for the deeper layers. If you dont, and just close with staples or non-absorbable sutures, the deeper layers won't be closed and you'll likely end up with more problems. The type of absorbable suture you use can affect suture spitting. Some are better than others for that. You can minimize the amount of suture you use, pick types that spit less, and close with staples or non-absorbable sutures on the skin (you will get worse scarring though from the non-absorbable outer layer).

Thank you for your detailed question regarding extended brachioplasty and your understandable concern about suture rejection. It sounds like you had a difficult experience with spitting sutures after your previous procedure, and you're now wisely looking into alternatives that might minimize complications, especially given your history of hidradenitis suppurativa (HS) in the axillary region.

Yes, it is technically possible to perform an extended brachioplasty without the use of dissolvable (absorbable) sutures, but some form of closure—either internal or external—is necessary. Most plastic surgeons use absorbable sutures internally to minimize external scarring, reduce the need for suture removal, and maintain long-term strength as the tissue heals. However, in patients with known sensitivity or a history of foreign body reaction (like yours), modifications can be made.

Instead of deep dissolvable sutures, your surgeon might use fewer layers or switch to non-absorbable sutures for closure, which can then be removed postoperatively. This reduces the risk of suture spitting but does require careful monitoring and often more frequent visits for removal. Tissue glue (like Dermabond) and surgical tape (such as Steri-Strips) can be used on the outermost layer, but they aren’t strong enough to hold the incision together on their own, especially for an extended brachioplasty where tension is higher. These methods are generally considered supplements rather than stand-alone closures.

Plastic skin closure clips (the ones you mentioned but couldn’t name) may refer to devices like ZipLine, Insorb, or Proximate skin closure systems. These can sometimes reduce external trauma and help manage healing without traditional external sutures or staples, but they still require a strong internal closure beneath.

If you are prone to infection, suture rejection, or have active HS, your surgical plan needs to be highly customized. I would strongly advise consulting with a board-certified plastic surgeon who is experienced in complex wound management and familiar with HS. Bring up your previous experience in detail during consultation, and ask about custom closure techniques such as layered interrupted sutures with low-reactivity materials, minimal use of foreign bodies, or staged wound closure if needed.

Sincerely,
Dr. Katzen

Thank you for your query. You will need at least one or two layers of sutures or staples to bring the skin and deeper tissues together. One way of minimising chances of the sutures spitting out will be to use a different kind of monofilament sutures for the deep layer and non-absorbable sutures for the skin or even steri-strips. The outside sutures can be removed a little early and glue applied. It would be best if you discuss your concerns with your surgeon including the kind of sutures that caused problems the last time. All the best!

You will need to have some sutures for an arm lift, at least for deeper tissues. For the more superficial layers you can discuss options with your surgeon since you had so many issues with spitting sutures in the past. Be sure to discuss with your surgeon how to care for your incisions to minimize risk of infection. Keeping the work area clean when caring for your incisions and using disposable gloves may help.

You will need some deep sutures, but non-dissolving sutures can be used on the skin. These will be removed in 1-2 weeks. prior to surgery, You need to use Hibiclens soap over your entire body about 3 days prior to surgery and continue to use it after. Also, please have someone check your Hemoglobin A1C if it has not been done recently and make sure your protein level is good. Also, your bathroom must be cleaned thoroughly prior to surgery. Many infections are picked up in the bathroom. Hands must be washed before and after each time you touch your incisions.