A Four-Layer Wound Closure Technique with Barbed Sutures for Stable Reset of the Inframammary Fold in Breast Augmentation.

Abstract

The inframammary fold (IMF) is an important anatomical landmark with regards to aesthetic appearance of the breast. After implantation a new IMF often needs to be recreated, sutured, and secured to its new position to avoid displacement during the healing process.1,2 In order to obtain optimal results it is crucial to achieve a well-defined and accurately positioned IMF with the scar lying exactly in it. To prevent scar dislocation it is also important to provide sufficient length of skin between the nipple and the fold. This length should be adjusted according to the amount of covering gland and to the implants height and projection.3 In this series, all implants were placed with a dual-plane technique but the importance of securing and stabilizing the submammary fold after implantation applies to all planes of implant placement in breast augmentation via a submammary incision. The authors present a simple method that provides accurate, stable, and long lasting repositioning of the new IMF with a four-layer wound closure technique using barbed sutures. These sutures have recently become more popular across a number of surgical specialties as well as in plastic surgery,4,5 since their introduction in 1967 for tendon repair.6 Implant selection and preoperative markings were made according to the “AK method” described by Heden.1,3 After implantation, the first layer of the closure consists of securing the new IMF to the thoracic wall. A 0 PDO Quill (Surgical Specialties Corporation, Wyomissing, PA) bidirectional barbed suture is run with strong bites between the thoracic fascia (at the level of the implant lower pole) and Scarpa's fascia at the inferior edge of the wound (Figure 1). Figure 1. The first layer of closure is demonstrated on a 32-year-old woman. The barbed suture is run with strong bites …