Permanent internal sutures - capsulorrhaphy

Question

I am going to have capsulorrhaphy , and an implant exchange (downsizing) in a few months. I have read that permanent internal sutures are necessary. Does this mean they are not dissolvable? Thank you.

Lisa Cassileth, MD, FACS · Answer

Capsulorrhaphy is closing down the pocket in select locations to move the implant. I have best results with actually removing or heavily cauterizing the area to be closed down, then oversewing it with a long acting, absorbable suture that keeps the area closed off until the pocket heals on its own (like 2-0 PDS). I'm not a fan of permanent, since I do a lot of revision breast surgery and I'm pulling out other surgeon's prolenes, ethibonds, nylons, and other sutures which failed in the first place. Keep in mind if you have a really weak natural capsule, especially with a big implant that goes out and down, and strong pecs, capsulorrhaphy may not be enough.

Richard Baxter, MD · Answer

With a capsulorrhaphy, it is not the sutures but the material being sutured that produces the long term result. The material being sutured is the scar capsule, which can be thin and weak or thick and strong. Once the healing has occurred, it is the tissue not the sutures that forms the new capsule dimensions. I have seen many failed capsulorrhaphies with permanent sutures. If the capsule is thin and weak it should be reinforced with an internal bra material such as Strattice, SERI, or Galaflex. If the capsule tissue is thick and strong, a slow dissolving suture works just as well as a permanent one.

Burr von Maur, MD · Answer

Permanent sutures are generally preferred for capsulorrhaphy procedures since permanent support of the implant is desirable. However,if supporting mesh material is used,absorbable sutures are also used.

Curtis Wong, MD · Answer

and you should be able to ask your surgeon to use the slowly dissolving sutures like PDS or Vicryl that will allow for adequate time for your pocket to heal.  In my practice, a cut out underwire bra is required for 6-8 months (including when showering) to help minimize the pressure on the incision line.  And even then, the procedure can fail where a revision may be needed so know what your surgeon's policy is before surgery.

Tom J. Pousti, MD · Answer

Thank you for the question. Yes, permanent sutures are not dissolvable.  You may find the attached link, dedicated to this type of revisionary breast surgery helpful to you as you learn more.   Best wishes for a successful outcome.

Arian Mowlavi, MD, FACS (license on probation) · Answer

Capsulorraphy or sewing of your capsule in your pocket can be done to improve implant position and subsequently breast shape. I use permanent sutures as well for  this procedure; Please see examples below of patients who have undergone breast augmentation revision.

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the question and YES permanent sutures are used with a capsulorraphy though there are other newer techniques that can be used to accomplish the same thing without permanent sutures.  So discuss that with your surgeon or other expert in the field.Dr. Corbin

Ronald V. DeMars, MD (Retired) · Answer

Yes, permanent means just that, they are there forever. That's the best way to go as the use of dissolving sutures often leads to failure of the operation. I have had to redo many capsulorrhaphies done elsewhere with temporary sutures.

Jon A. Perlman, MD (retired) · Answer

I agree with your surgeon's plan to change to smaller implants and place sutures to elevate your implants and close off portions of their pockets. I do not and have never used permanent sutures but do you slowly dissolving sutures that last for about 2-3 months. Allow your surgeon to use the technique that he/she is most comfortable and successful with. Regards,Jon A Perlman MD FACS

Certified, American Board of Plastic Surgery

Extreme Makeover Surgeon ABC TV

Best of Los Angeles Award 2015, 2016

Beverly Hills, Ca

Certified, American Board of Plastic Surgery

Extreme Makeover Surgeon ABC TV

Best of Los Angeles Award 2015, 2016

Beverly Hills, Ca

Permanent internal sutures - capsulorrhaphy

Answers (9)

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