What Kind of Sutures Are Used in Capsulorrhaphy? (photo)

Question

I am having capsulorrhaphy and implant exchange on Sept 10. I am going from 500cc HP to 375cc HP. I have slight bottoming out too. My PS is going to stitch down my incision, what kind of stitches/sutures are used? I am 32 band and my rib cage is 28".

Jed H. Horowitz, MD, FACS · Answer

One of the most common problems is breast capsule contracture or the development of thickening, and contracture of the capsule that exists around the breast implants. As it thickens and shrinks, the patient may develop a feeling a firmness of the breasts and in its worst situation, the breast may become painful and abnormal in appearance, achieving a very round, hard, and uneven appearance. There may be distortion and possible breakage and leakage of an older implant, but may also include a newer implant.  A #capsulotomy or opening of the breast capsule may be required for the removal of a scarred capsule.  Capsulotomy or the opening up of the #capsule may be required or frequently #capsulectomy, which is removal of the scarred capsule, is recommended to ensure adequate pocket dimensions.New implants may then be placed in the same existing position or may undergo a change of placement frequently from submammary to subpectoral position and, on occasion, the other way around.

Robert L. Steely, MD, FACS · Answer

good morning!

	Every surgeon has his/her preferences when choosing what type of suture to use when performing a capsulorrhaphy or and "internal bra" procedure.  What is pretty much standard is using nonabsorbable sutures to insure that the repair remains true for many years to come.

	 

	I hope this helps

Ronald J. Edelson, MD · Answer

Different surgeons will use different types of sutures, but for the most part they use non absorbable sutures so the bottoming out does not recur.

Vincent N. Zubowicz, MD · Answer

Any modifications to the pocket that require suture will be at the discretion of the surgeon. They may be permanent or dissolvable and of different caliber. You can ask your surgeon what he intends to use.

Tom J. Pousti, MD · Answer

Practices will vary.  I find the most success utilizing a two layer permanent suture capsulorraphy repair.   Sometimes, depending on the patient's situation, the use of additional supportive material such as  acellular dermal matrix is also helpful  Best wishes.

Jeffrey Zwiren, MD · Answer

A capsulopexy usually involves a wedge type excision of redundant capsule and a layered repair.  In general most plastic surgeons will opt of a non-absorbable type of suture material for this repair.

John Q. Cook, MD · Answer

Different surgeons use different sutures. This would best be discussed with your surgeon as he or she has the best understanding of your circumstances. My personal preference is to use nonabsorbable sutures with a running overlay of absorbable sutures. In severe cases acellular dermal matrix can be of help, but it doesn't sound like that will be necessary in your case.

Vincent P. Marin, MD, FACS · Answer

Many different sutures are used in capsulorrhaphy procedures. This varies from surgeon to surgeon. You should ask your surgeon directly to know more of what he or she prefers.

Best of luck,

Vincent Marin, MD
	San Diego Plastic Surgeon

Mary Lee Peters, MD (retired) · Answer

Making an implant pocket smaller, a capsolorraphy, is done by many different methods. The variety of different techniques shows you that there is no single "best" method. Most surgeons will choose a type of stitch that does not dissolve. There are many different types of non dissolving permanent sutures, and the exact suture type is probably not that critical. Sometimes a support material, such as Strattice or Alloderm is used to help hold the closure. Use of a proper bra afterwards is important to maintain the new pocket boundaries.

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