The first suture is a 4-0 poliglecaprone (Monocryl) between point A and the 12 o’clock point of the NAC. The second suture is a 3-0 polydioxanone (PDS II) between points B and C and the 6 o’clock point of the NAC (Fig.
4D). Superior traction is applied to the ends of the second suture.
3 (link),4 (link) This elevates the inferior vertical limb, which is then closed with deep interrupted 3-0 polydioxanone (PDS II) sutures.
The peri-areolar closure is completed with 4-0 poliglecaprone (Monocryl) deep interrupted sutures at the 3 and 9 o’clock positions, followed by four more sutures, halfway between these points. A 3-0 white polyester suture soaked in Betadine is then placed as a buried purse-string suture around the areola, which is then tightened around the areola marker.
37 ,38 Placement of the purse-string suture also helps define the length of the vertical scar.
The patients are placed in a seated position. If necessary, tailor tacking is performed on the vertical inferior ellipse and any planned horizontal closure in the IMF. Usually, as the vertical incision is closed, the IMF establishes its own level, and a vertical incision continues onto the abdominal wall (Fig.
4E). Excess subcutaneous fat at the inferior end of the vertical incision can be reduced using liposuction or direct excision. If an IMF horizontal excision is performed, it is closed with deep 3-0 polydioxanone. The primary author prefers to evaluate the breast shape postoperatively performing a delayed horizontal excision after 6 months.
The final closure of the vertical and horizontal incision is completed with deep interrupted and subcuticular 4-0 poliglecaprone. The final periareolar closure is a subcuticular 4-0 poliglecaprone. The closure of the vertical incision is initiated 1 cm below the 6 o’clock position of the areola, to prevent areola creep
3 (link) and distortion of the areola. Half-inch Steri strips are applied.
Xeroform gauze is placed on the areola with the nipple exposed, followed by gauze secured with Tegaderm. A soft postsurgical bra (Design Veronique) is applied but is optional.
Kirwan L., Wazir U, & Mokbel K. (2023). Simultaneous Salvage Auto-augmentation: Contemporary Strategy for Management of the Breast Explantation Patient. Plastic and Reconstructive Surgery Global Open, 11(3), e4860.