Efficacy of STRATAFIX in Inframammary Fold Recreation in Autologous Breast Reconstruction.

Supplemental Digital Content is available in the text.

The inframammary fold (IMF) is not merely the border of a woman’s breast, but it structurally supports the breast and defines its overall shape. When its definition is compromised during mastectomy, the breast loses its natural appearance unless the IMF is recreated.[1] In implant-based breast reconstruction, caudal malposition of the IMF rarely occurs once capsule formation is complete. However, in autologous breast reconstruction, caudal malposition of the IMF often occurs postoperatively due to loosened sutures or the weight of the skin flap. Therefore, a suture with little slack and able to withstand the flap weight is ideal for IMF recreation. STRATAFIX Symmetric PDS Plus (STRATAFIX, Ethicon Inc., New Jersey, USA) is a knotless suture device developed for tissue closure in high-tension areas. Suture anchors capture the tissue 3-dimensionally, allowing running sutures to secure tissues under strong tension for long periods, with 50% of the tensile strength preserved 6 weeks postoperatively.[2] In this study, we examined the efficacy of STRATAFIX in IMF recreation in autologous breast reconstruction.

Participants included 18 patients who underwent both breast reconstruction using the deep inferior epigastric artery perforator flap and IMF recreation, from September 2015 to May 2017 in our department. The STRATAFIX group, consisting of 8 patients who underwent IMF recreation using running sutures with STRATAFIX (CTB-1, taper point, suture size 1), and the PDS group, consisting of 10 patients who underwent IMF recreation using multiple interrupted sutures with PDS (suture size 0, Ethicon Inc.) were compared. There was no significant difference in mean age, mean body mass index, and mean flap weight between the 2 groups (P > 0.05, Student’s t test, Table 1). IMF recreation was performed using the methods reported by Nava et al.[3] In immediate reconstruction, the superficial fascia and chest wall were sutured together, and in 2-stage reconstruction, the superficial fascia and capsule on chest wall were sutured together. Six months postoperatively, the difference in IMF position compared with the contralateral side was measured in the standing position. Please refer to the video for the actual operative technique (see video, Supplemental Digital Content 1, which displays intraoperative techniques for inframammary recreation using STRATAFIX. This video is available in the “Related Videos” section of PRSGlobalOpen.com or at http://links.lww.com/PRSGO/A749).

Table 1.

Patient Characteristics and Operative Results

See video, Supplemental Digital Content 1, which displays intraoperative techniques for inframammary recreation using STRATAFIX. This video is available in the “Related Videos” section of PRSGlobalOpen.com or at http://links.lww.com/PRSGO/A749.

In the STRATAFIX group, postoperative caudal malposition of the IMF was seen in 2 of 8 cases, whereas in the PDS group, it was seen in 6 of 10 cases (Table 1). In terms of perioperative complications, aside from 1 case of abdominal flap donor-site infection in the PDS group, no significant complication was seen in either group. The sutures could be palpated in both groups at 3 months postoperatively, but not at 6 months. Please refer to Supplemental Digital Content for representative cases (see video, Supplemental Digital Content , which describes representative cases of inframammary fold recreation using STRATAFIX. This video is available in the “Related Videos” section of PRSGlobalOpen.com or at http://links.lww.com/PRSGO/A750).

See video, Supplemental Digital Content 2, which describes representative cases of inframammary fold recreation using STRATAFIX. This video is available in the “Related Videos” section of PRSGlobalOpen.com or at http://links.lww.com/PRSGO/A750.

With STRATAFIX, suture anchors capture the tissue 3-dimensionally, allowing running sutures to secure tissues under strong tension for long periods. Thus, in IMF recreation using STRATAFIX, the sutures are thought to loosen less from flap weight before scar formation is complete. Some precautions on the use of STRATAFIX include the need of a surgeon with some experience, as closure must be accomplished with a single running suture. In addition, when a long piece of the suture is left after flap placement for the lateral IMF recreation or other adjustments, the suture may become entangled with blood vessels.