Tubular Breast with Mastoplexy: is a Permanent Purse String Suture Needed?

I have asymmetrical tubular breast and have been told that I need a concentric mastoplexy and augmentation. I have been told by some doctors that they always do a permanent purse string suture to keep the nipple from expanding. Others say that you can always feel this suture and that it is not necessary. I do not want my lover to be able to feel the suture when we are intimate. Is it necessary and what are the risk of not doing it?

Doctor Answers 19

Tubular breast correction with mastopexy

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It is hard to tell for sure from the side view, but you do not seem to have too much asymmetry. I would stay away from any permanent pursestring suture. In general the periareolar mastopexy which requires a pursestring suture has the risk of release of that suture and delayed deformity around the areola causing radial striations that are difficult to fix.

If the asymmetry warrants more than a conservative periareolar reduction I have found that the full mastopexy creates complete release of the deformity and have been able to achieve excellent symmetry between the breasts. I recommend using implants on both sides so that the symmetry is more readily achievable.

Providence Plastic Surgeon

Tubular breast deformity and mastopexy using purse string technique

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As you can see from previous post your particular breast shape presents a difficult reconstructive problem. In my experience periariolar mastopexy with augmentation to reshape and thrust the breast is usually not the answer.

If you wish you can go on my site and include your email address and I can send pix of treatment of a similar case.

Barry H. Dolich, MD (Retired)
Bronx Plastic Surgeon

Suture technique in Tuberous Breast reconstruction

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The determining factor in the need for a permanent versus semi-permanent suture is the degree of tension placed on the periareolar lift. When the areolar is relatively normal in size and the amount of elevation is small, such as in your case I have found that a long lasting but not permanent suture gives the best results. Because the difference in the circumferences of the two concentric circles needed in your case are not that great then there is less outward tension on the areolar and hence less chance of spread. When the opposite is the case and the two circles have significant difference in their circumferences then a permanent suture is more appropriate. As you mention there is a chance of palpation, so I attempt to avoid them if possible. In the proper hands you should get your desired result.

See link below for the before & after photos of a patient with breasts similar to your own. Regards, Dr. DeLuca

Tuberous ( Constricted) Breast Correction?

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Thank you for the question and picture

You have appropriately heard of the downsides of using permanent as well as the downsides of using absorbable sutures.  Unfortunately, there is no perfect solution.

For “minor” tuberous breasts correction options very. Sometimes it is possible to  use breast implants only without an incision around the areola;  patients  potentially will contain to have a “puffy” areola appearance.In other cases of “minor” tuberous breast  anomaly,  breast augmentation and circumareola reduction may be selected as the operation of choice. Which operation the patient chooses will depend on the aesthetic result they are looking for.

Generally, some of the characteristics seen with tuberous breasts include a very narrow base, short distance from areola to inframammary fold, tight (constricted) lower pole of the breasts, relatively wide space between the breasts, "puffy" and areola and some degree of ptosis (drooping).  

Generally,  correction of tuberous breast anomalies involves breast augmentation with areola reduction / mastopexy procedure. The distance from the inframammary fold is increased (to create a more rounded out appearance). Proper implant positioning improves the distance (cleavage) between the breasts. The areola reduction helps to treat the pointed and "puffy" appearance of the areola.

In the most severe cases of tuberous breast, a more complete breast lift may also be necessary.  In many cases however, a lift is not necessary. The patient should be aware that the final result will take months to see and that they will need to be patient and that revisionary surgery is more likely than in patients who do not present with tuberous (constricted) breasts.
When you are ready, please make sure you consult with well experienced board-certified plastic surgeons who have significant experience with this type of surgery.

I hope this helps.

Tubular Breasts and Permanent Suture

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Tubular breast deformity is characterized by a narrow or constricted breast base. The breast tissue is then herniated into a, usually, widened areola. The deformed breast my be paired with a normal breast or a breast with any number of other deformties.

The correction involves an augmentation mastopexy. Because of the large expansion of the breast tissue with the implant there is a tremendous amount of stress on the areola. This often results in widening of the areola to a very unnatural size.

I like to use a permanent stitch, Gortex, to prevent this widening. I don't think you can really detect that it's there. Frankly, your lover won't question you about it.

Circumareolar Mastopexy

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Hi there-

You are among the very small group of women for whom I believe a circumareolar approach to mastopexy is ideal.

One of the major problems with this operation is the spreading of the areola that can occur- the areola gets larger and becomes a larger than preferred focal point on the breasts... Generally patients hate this look.

In order to avoid this, it is necessary to use a suture that holds its strength until the new breast shape is stable.

There are going to be many differences of opinion on which suture is best for this (asking surgeons which suture they like best is a bit like asking what car they drive.. its going to come down to preference).

Find a surgeon you like and trust and follow their recommendations.

Control the expansion

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I understand your concern. In my opinion a permanent suture will control the shape of your areola much better. A absorbable suture can be used but you must be will to accept the trade-off, a stitch you or your lover can not feel over time versus the possibility of wider areola of the breasts. Consult with several board certified plastic surgeons for an evaluation.

Good Luck

Tubular breasts

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Yes, you will most likely need a circumareola control suture for your areola. This can be performed with a soft suture like Gortex which is barely palpable, if at all.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Permanent stitch for augmentation mastopexy correction of tuberous breasts

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To some degree a lift and augmentation are conflicting operations. In one you are removing skin to create a "lifted" breast and in the other you are placing an implant whihc stretches the skin. If you do not use a permanent suture, you will risk enlargement of the areola. Necessity of the suture is a function of your cosmetic expectations.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Permanent vs dissolving suture for tubular breast mastopexy

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You can tell from the various answers that there are differences of opinion about the use of premanent sutures. You will definitely need a pursestring (Benelli) mastopexy. With permenent sutures, there are actually a couple of issues, one of which is that it can be felt even if it is in a deep layer. Another is that the areolar diameter normally expands and contracts depending on temperature, stimulation, etc; if it is fixed by a permanent stitch, then it has to pooch out like a snoopy dog profile instead of expanding. For that and other reasons, I prefer to use a slow-dissolving suture so that there is time to heal before the areola expands from tension on the skin. But there is no single best answer on this, just differences of opinion. See the link below for a video of the procedure.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.