Permanent vs dissolvable sutures for areola reduction?

Question

Hi!! From what I’ve seen, the best results with areola reduction come from permanent sutures. I’ve read TONS of reviews where they get a second surgery done (1st time dissolvable, 2nd permanent) because they streched back out between 6mon-1year to the original size or bigger. When spending $6k, that is extremely concerning and steers me toward permanent. BUT I’m struggling to find a dr that uses permanent sutures for reduction. Should I feel comfortable moving forward with dissolvable?

Randal Haworth, MD, FACS · Answer

The choice between dissolvable and permanent sutures for areola reduction is a decision that should be made in consultation with a qualified and experienced plastic surgeon. Both options have their pros and cons, and the right choice may depend on various factors, including your specific anatomy, healing process, and the surgeon's preferred techniques.

A skilled surgeon can provide insights into their preferred methods, potential outcomes, and address your concerns, helping you make an informed decision that aligns with your expectations and comfort level.

Best of luck !

Daniel Barrett, MD · Answer

Dear kaibbaby,
it is hard to tell for sure without an examination. Every surgeon has a preferred technique that he/she uses. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Pedro Rodriguez, MD · Answer

Hi. Your question is a great question that always sparks some good conversation and discussion between plastic surgeons and patients alike. While there are multiple factors to consider it all evolves on how much of a reduction we need to perform, what is the excess skin present and how much tension will there be after the areolar reduction is performed. For patients that need a 1 to 1.5 cm reduction with none or minimal tension, I perform the areolar reduction with absorbable sutures. In those cases, I use PDS sutures which take several months to finally dissolve. 
For reductions that involve 1.5 to 2 cm, I use permanent sutures as those areolar reductions usually have a little more tension and hold better with permanent sutures. Pass 2 cm, patients usually need at minimum a vertical skin resection (lollipop incision) for better long-lasting tension free results.
As with any surgical procedure, a full evaluation by a board-certified plastic surgeon is always recommended to design a surgical plan based on your particular body and needs. 
Hope you have a great areolar reduction surgery:)
Pedro Rodriguez, MD

Jeffrey J. Roth, MD, FACS · Answer

Thank you for your question. Typically, when closing an incision, absorbable sutures are used under the skin to achieve a good structure, and take tension off of the outer most part of the skin, (epithelium). When performing an areola reduction, we typically will place a purse string suture in the dermis layer around the Nipple Areolar Complex (NAC). This suture is made of permanent material, (nylon, prolene, gortex). This keeps the tension down, and should keep the NAC from spreading. Usually this suture stays buried under the skin. Rarely, the knot might poke out, and so the suture may need to be taken out. We try and wait at least 6 months before taking the suture out. Most women want the NAC to be about 4 cm in diameter. Best to talk with your Board Certified Plastic Surgeon. Together you will make a plan.

Jeffrey J. Roth, M.D., F.A.C.S.

Board Certified Plastic Surgeon

Las Vegas Plastic Surgery

Jeffrey J. Roth, M.D., F.A.C.S.

Board Certified Plastic Surgeon

Las Vegas Plastic Surgery

Ira H. Rex III, MD · Answer

in my practice and  in textbooks covering the subject, it is mostacceptable to use non-absorbable sutures for and areolar reduction. This is not always a perfect solution, because the sutures can break, get exposed and need removal, and the areola can stretchh beyond these sutures in some circumstances. It's often good to get a second opinion from another plastic surgeon.

Mats Hagstrom, MD (license on probation) · Answer

The outcome of this procedure depends on a number of different variables.
The first one is how much skin is removed.
The more of a reduction you have the more likely the scar is to widen with undesirable side effects.
People also heal very differently, and some people have tissue that’s prone to stretching after surgery while others have tissue with much better tissue. Integrity that hold the repair better.
Suture material cannot be relied on to maintain strength indefinitely. Even permanent suture will eventually loose its strength.
Suture material is only one variable out of many to determine the outcome of this procedure.
A woman with 6 inch areolas that are reduced down to an inch and a half is going to have problems after the procedure.
There is no yes, or no right or wrong answer to your question.
That’s why surgeons have different ways of doing this.
If there is no definitive way of doing the procedure, if there was a better than we would all be doing the same thing.
There is a reason why we choose to suture material we do.
We’re not hoping that patients have failed outcomes and need revision surgery.
Best,
Mats Hagstrom, MD

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