Should I be worried about having staples used with a breast reduction?

Question

I had a consult for a breast reduction and one thing that scared me was he uses staples under the breast crease. I am freaking out about scaring. He is coming very highly recommended to me but I don't know what to do. He retires in 4 months and so would only be around 3 months after my surgery. They say someone is looking into buying the practice but that is all. Nothing is set in stone. Any advice is appreciated. Thanks!!

George Marosan, MD · Answer

Thank you for the question. I personally prefer to use staples in my breast reductions (I use a vertical breast reduction technique) in the vertical scar only. The reason I use staples is that it approximates the skin edge without strangulating it (cutting off the blood supply to the very edge of the skin like sutures can do). It is important to close the underlying tissues well without leaving tension at the skin suture line. Staples need to be removed within 5 days and then I use tape over the incision for 2-3 weeks. This is very technique dependent, your surgeon must pay close attention to detail. Since I switched to staples, my vertical scars heal with almost unnoticeable scars. BTW, I use sutures around the areolae, but without tension at the skin level. If you have an anchor type scar reduction, staples might leave marks long term. The reason is that, this type of closure is often done under significant tissue tension and with the additional post op swelling, more skin edge strangulation can happen. See a board certified plastic surgeon and look at his/her post op photos and scar quality.

Gary M. Horndeski, MD · Answer

I never use skin staples on any breast reductions.  I prefer long lasting slowly absorbing
sutures.  The advantage of sutures is
that by the time the sutures dissolve the wound has gained mechanical
strength.  When staples are removed early,
there is very little mechanical strength and the wound separates resulting in
wide scars. Best Wishes,Gary Horndeski, M.D.

Charles Cope, MD · Answer

Hi. Most surgeons do not use stapes with breast reductions, but as long as the staples are taken out early this should not be a problem. Ask to see photos of patients who have had staples used to see what the scars look like. Most scars on the breast heal without problems, but occasionally there can be thick (hypertrophic) scars that need other treatment such as the medical grade Fraxel laser to improve them. Regards Dr Charles Cope

William T. Stoeckel, MD · Answer

Most surgeons do not use staples with reductions. But that does not mean that it shouldn't be done. I have seen the results of some surgeons that use staples and the scars are just fine. As long as the staples are removed in a timely manner, the scarring can be the same as with sutures. Ask to see some photos of the scars of the surgeon's patients. I bet that they are just fine and it will ease your mind. I personally do not like the type of breast reduction that uses a horizontal scar in the breast crease. In my opinion, a vertical reduction (Hall Findlay technique) can be utilized in almost all patients and only requires a vertical scar and one around the areolae. You might want to find a surgeon that uses this technique. The issue with retiring after 4 months could be OK to. But you would need to have some assurance that you will have someone to follow up with in the case of any problems. Most breast reduction patients do not have problems and you will probably be fine at 3 months. But I would want to be able to see someone in the case of a problem.

Lisa Cassileth, MD, FACS · Answer

I think staples are used for a quick and easy closure and most plastic surgeon would not use them on a breast. If you leave them on long enough for them to really hold the skin together, they leave scars. If you take them out after a few days, then the incision does not have the proper amount of closure post-operatively. I prefer deep interrupted subcuticular sutures with a running subcutaneous suture, which you cannot see and they absorb on their own. Maybe - MAYBE you could make an argument that they are ok in the scalp for certain hairline lifts. Even then, ick!

Steven Wallach, MD · Answer

Staples are ok to close a breast reduction as long as they are removed sooner than later.  Best to discuss your issues with your surgeon.

Peter Callan, MBBS, FRACS, MBA · Answer

Like all techniques it depends how they are used.  Staples used to align the skin edges only and then removed early (few days) do not leave any scars at all. The advantage of staples is there is no "cross-pressure" across the wound, unlike external sutures. However just ask your surgeon how they are used. They are a very good technique when used appropriately.

Angela Keen, MD · Answer

Staples are actually a very good if only left in a few days.  The thing you might want to look into is finding a surgeon who uses the vertical scar technique so you don't have that large under the breast scar!

Rick Rosen, MD · Answer

I think you have reason to be concerned. I would ask to see photos of recent patients that have had the procedure or ask to have one of his prior breast reduction patients contact you. The scarring is important. You can have a nice shape post op but if the scars are not nice, then the result is not what you wanted. I do not use staples other than in hair bearing areas i.e. the scalp only. You have waited to have the procedure done for years, be sure before you continue.

Samer W. Cabbabe, MD · Answer

Personally I do not use staples on the breast ever as I am concerned about scarring from the staples.   I don't mind spending a little extra time to put a suture that dissolves in my patients breasts.  Removing the staples is never a comfortable process for patients.

Should I be worried about having staples used with a breast reduction?

Answers (12)

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