Suturing Technique for Less Scars?

Our before-after gallery has several examples of patients who had short scar surgery, had an unsatisfactory result, and had a surgery to convert those results to a longer-scar technique... with improved results!

So my colleagues are right on in noting that it is the surgeon, not the technique, that will give you the greatest chance of obtaining a great result.

It is often a mistake to try to get too much correction from minimal incisions techniques.  A fine plastic surgeon who has "seen it all" can tell you which technique would be recommended ... and why.

Scars are not a direct result of the suturing technique although it is one important factor. Other issues relate to a person's genetic tendencies for healing, the wound tension, suture material, medical history, age, etc.

The technique that leads to the best scars is a closure without tension on the skin and if it is placed in the natural wrinkle lines. Scar quality is also influenced by you ethnicity, healing ability, infection, etc. You will probably have an anchor scar reduction, and with this technique there's significant tension on the infamammary crease suture line due to the design of this operation. This incision is at higher risk for thick, raised hypertrophic scars. 

There isn't any one best technique or suture type that always produces the best scar, and your plastic surgeon will make the choice based on experience. Other factors such as tension on the skin edges are ultimately more important.

Thank you for the question.

Generally, layered closure of all tissue planes will allow for as little tension as possible on the superficial layers of skin. This relatively “tension free” closure of the final layer may help scars remain as fine as possible. You should keep in mind,  that despite a surgeon's best efforts,  some scars do not heal as well as he/she hopes.In these cases, scar revision surgery may be necessary.

Generally, breast reduction surgery is a very patient pleasing operation ( given the relief of symptoms)  despite the presence of scars.

Best wishes.

Unfortunately whenever you cut the skin you will get a scar and breast reduction surgery is associated with reasonably lengthy scars as a result of removing the excess skin, fat and breast tissue. Although the length of overall scar is an important issue, the quality of the scar is equally so and fortunately most scars will heal quite nicely. You will need to be patient however as the scars will change dramatically as they evolve over the year after surgery. Most plastic surgeons will use a multi-layered suture technique with fine sutures to lead to the most well healed scar. Unfortunately there is no magical technique.

Surgical technique including placing virtually all of the sutures deep to the skin will help you obtain the best possible result given your particular genetic issues and skin characteristics. Longer lasting dissolvable sutures can protect the incisions for a greater period of time thereby providing you with the best opportunity to obtain narrower scars.

Using surgical tapes for a few weeks after surgery followed then by scar reduction agents such as Mederma, silicone gel or silicone strips are important as well.

I do recommend that you seek treatment from a reputable and qualified board certified Plastic Surgeon.

As some of the comments point out, the specific suture technique generally does not matter as much as the tension, patient genetics, age, etc. However, things can be done AFTER the surgery to minimize the scars. One option that has been demonstrated to work in well designed scientific studies is silicone gel which comes in sheets that can be applied to scars starting 1-2 weeks after surgery. For best results, it should be used at least 12 hours per a day for at least 2 to 3 months. The cost is about $100 to $200 for the length required for a breast reduction and it can be found on many internet sites.

Although a patients genetic predisposition plays a very large role in scarring, there are a few surgical techniques that can minimize scarring:

1.tension free closure of the incision-this means ensuring the skin envelope is not too tightly closed over the remaining breast tissue

2.  careful handling of tissues:  crush injury to the tissue edges can lead to loss of blood supply (ischemia) and result in poor healing

3.  appropriate antibiotic prophylaxis:  taking precaution to minimize infection can minimize the risk of associated scarring.

4.  wound dehiscence precautions: light activity without lifting for 4-6 weeks post breast reduction surgery will minimize your chance of a wound breakdown, which can result in significant scar formation.

 

I hope this helps and all the best in a safe and happy recovery

 

Paul S. Gill, M.D.

Gill Plastic Surgery

Houston Double Board Certified Plastic Surgeon

All plastic surgeons do their best to leave their patients with theleast amount of scarring.  This can be minimized by using less incisions and non-reactive suture material with little to no tension.