Efficacy and Safety of Barbed Sutures for Capsulorrhaphy in Implant-Based Breast Reconstruction

Overview

Journal Eplasty

Specialty General Surgery

Date 2024 Oct 30

PMID 39474008

Authors

Madison Rose Tyle

Matthew Nester

Mariel McLaughlin

Amra Olafson

Nicole K Le

Kristen Whalen

Cameron Juybari

Emily Coughlin

Rahul Mhaskar

Paul D Smith

Deniz Dayicioglu

Affiliations

Soon will be listed here.

Abstract

Background: A common postoperative challenge following implant-based breast reconstruction surgery is lateral or inferior displacement of the implant, which ultimately requires surgical intervention to shape the pocket for improved symmetry. Capsulorrhaphy is traditionally performed with smooth sutures, but the use of barbed sutures has proven to be more efficient and effective in other plastic surgery procedures. This study aimed to demonstrate the safety and efficacy of barbed sutures for breast reconstruction implant capsulorrhaphy.

Methods: A retrospective cohort study was performed including all consecutive patients who underwent capsulorrhaphy by the senior author utilizing barbed sutures and, for comparison, another colleague utilizing smooth sutures from the years 2018-2021.

Results: Twenty-eight patients were identified who underwent barbed suture capsulorrhaphy (a total of 36 breasts operated on), which was compared with 20 patients who had smooth suture capsulorrhaphy (a total of 34 breasts operated on). The average ages of the barbed and smooth suture cohorts were 55 and 53 years old ( = 1.00), respectively. The average BMI of the barbed and smooth suture cohorts were 26.7 and 25.0 kg/m ( = .15), respectively. The reoperation rates for both groups were similar at 5%. Overall complication rate was 13.9% in the barbed suture group and 8.8% in the smooth suture group, which was not statistically significant ( = .71). Patients with barbed sutures did not have an increased risk of complications compared with those who received smooth sutures (OR 1.67 (0.37-7.59), = .51).

Conclusions: In conclusion, performing implant-based breast reconstruction capsulorrhaphy with barbed sutures is a safe and effective procedure as compared with smooth sutures.

References

Harris R, Raphael P, Harris S . Thermal capsulorrhaphy: a modified technique for breast pocket revision. Aesthet Surg J. 2014; 34(7):1041-9. DOI: 10.1177/1090820X14542650. View

Sarkisian N, Mulon P . Comparison between barbed and conventional sutures for longitudinal thelotomy closure in an bovine model. Can Vet J. 2022; 63(5):535-539. PMC: 9009743. View

Durand C . Comparison of Knotless Barbed Suture Versus Monofilament Suture in the Oral Cavity of Cats. J Vet Dent. 2017; 34(3):148-154. DOI: 10.1177/0898756417715869. View

Panchal H, Matros E . Current Trends in Postmastectomy Breast Reconstruction. Plast Reconstr Surg. 2017; 140:7S-13S. PMC: 5722225. DOI: 10.1097/PRS.0000000000003941. View

Montemurro P, Avvedimento S, Heden P, Quattrini Li A . A Four-Layer Wound Closure Technique with Barbed Sutures for Stable Reset of the Inframammary Fold in Breast Augmentation. Aesthet Surg J. 2016; 36(8):966-71. DOI: 10.1093/asj/sjw011. View

Albornoz C, Bach P, Mehrara B, Disa J, Pusic A, McCarthy C . A paradigm shift in U.S. Breast reconstruction: increasing implant rates. Plast Reconstr Surg. 2012; 131(1):15-23. DOI: 10.1097/PRS.0b013e3182729cde. View

Aliano K, Trostler M, Fromm I, Dagum A, Khan S, Bui D . A Comparison of Barbed Sutures and Standard Sutures with regard to Wound Cosmesis in Panniculectomy and Reduction Mammoplasty Patients. Plast Surg Int. 2016; 2016:7590396. PMC: 5153480. DOI: 10.1155/2016/7590396. View

Spear S, Little JW3rd . Breast capsulorrhaphy. Plast Reconstr Surg. 1988; 81(2):274-9. DOI: 10.1097/00006534-198802000-00026. View

Bogliolo S, Musacchi V, Dominoni M, Cassani C, Gaggero C, De Silvestri A . Barbed suture in minimally invasive hysterectomy: a systematic review and meta-analysis. Arch Gynecol Obstet. 2015; 292(3):489-97. DOI: 10.1007/s00404-015-3653-x. View

10.

Miller K, Siegel R, Lin C, Mariotto A, Kramer J, Rowland J . Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016; 66(4):271-89. DOI: 10.3322/caac.21349. View

11.

Buchanan P, Abdulghani M, Waljee J, Kozlow J, Sabel M, Newman L . An Analysis of the Decisions Made for Contralateral Prophylactic Mastectomy and Breast Reconstruction. Plast Reconstr Surg. 2016; 138(1):29-40. DOI: 10.1097/PRS.0000000000002263. View

12.

Sundaram K, Piuzzi N, Klika A, Molloy R, Higuera-Rueda C, Krebs V . Barbed sutures reduce arthrotomy closure duration and suture utilisation compared to interrupted conventional sutures for primary total hip arthroplasty: a randomised controlled trial. Hip Int. 2020; 31(5):582-588. DOI: 10.1177/1120700020911891. View

13.

Adler D, Ostergaard S, Jorgensen E, Jacobsen S . Bidirectional knotless barbed versus conventional smooth suture for closure of surgical wounds in inguinal castration in horses. BMC Vet Res. 2020; 16(1):250. PMC: 7368766. DOI: 10.1186/s12917-020-02449-6. View

14.

Siegel R, Miller K, Jemal A . Cancer statistics, 2019. CA Cancer J Clin. 2019; 69(1):7-34. DOI: 10.3322/caac.21551. View

15.

Sando I, Billig J, Ambani S, Kraft C, Kidwell K, Zhong L . An Evaluation of the Choice for Contralateral Prophylactic Mastectomy and Patient Concerns About Recurrence in a Reconstructed Cohort. Ann Plast Surg. 2017; 80(4):333-338. DOI: 10.1097/SAP.0000000000001258. View

16.

Chasan P, Francis C . Capsulorrhaphy for revisionary breast surgery. Aesthet Surg J. 2008; 28(1):63-9. DOI: 10.1016/j.asj.2007.07.007. View

17.

Velotti N, Manigrasso M, Di Lauro K, Vertaldi S, Anoldo P, Vitiello A . Barbed suture in gastro-intestinal surgery: A review with a meta-analysis. Surgeon. 2021; 20(2):115-122. DOI: 10.1016/j.surge.2021.02.011. View

18.

Anand S, Jukic M, Krishnan N, Pogorelic Z . Barbed Versus Non-Barbed Suture for Pyeloplasty via the Minimally Invasive Approach: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A. 2022; 32(10):1056-1063. DOI: 10.1089/lap.2021.0868. View

19.

Villa M, White L, Alam M, Yoo S, Walton R . Barbed sutures: a review of the literature. Plast Reconstr Surg. 2008; 121(3):102e-108e. DOI: 10.1097/01.prs.0000299452.24743.65. View

20.

Gardella B, Dominoni M, Iacobone A, De Silvestri A, Tinelli C, Bogliolo S . What Is the Role of Barbed Suture in Laparoscopic Myomectomy? A Meta-Analysis and Pregnancy Outcome Evaluation. Gynecol Obstet Invest. 2018; 83(6):521-532. DOI: 10.1159/000488241. View