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Abstract

Sir:FigureAbsorbaTack is a sterile, one-time use fixation device. It is a synthetic polyester copolymer derived from lactic and glycolic acids that is absorbed over 3 to 5 months. It has been used to secure mesh in hernia repairs. Larcher et al. reported the first use of AbsorbaTack in breast reconstructions, using it to secure acellular dermal matrix to the inframammary fold. AbsorbaTack is absorbable, so there is no concern of a long-term foreign body presence that could serve as a nidus for infection. This is a distinct advantage over the commonly used nonabsorbable suture, such as Ethibond, which often requires removal during later stages of reconstruction due to its persistent dyed knots, especially in thin-skinned patients. We, however, routinely use absorbable sutures such as Vicryl to fixate acellular dermal matrix without any dehiscence of the acellular dermal matrix over the long term. It appears that a major advantage that AbsorbaTack has over sutures is its easy application. In our experience, suturing acellular dermal matrix to the chest wall has not been cumbersome in most reconstructive cases. Even with a typical skin-sparing or periareolar nipple-sparing mastectomy incision, due to the centrally located incision and absence of breast parenchyma, placement of inframammary fold sutures is quite convenient with conventional methods. However, with an inferolateral mammary incision (as in some nipple-sparing mastectomies) or in secondary corrective breast augmentation cases, placement of inframammary fold sutures can be difficult. We can certainly appreciate the utility of a device such as AbsorbaTack in these selected cases. A major disadvantage of AbsorbaTack is its cost. At about $625 per device with a minimum of 15 tacks, the applicator is disposed of once it has been opened. This is a premium compared with Vicryl sutures (at about $7 per suture). Therefore, without significant advantages over traditional sutures, AbsorbaTack may find only limited use in breast surgery. Allen Liu, M.D. Lifei Guo, M.D., Ph.D. Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass.