Use of Absorbable Dermal Stapler in Reduction Mammoplasty: Assessing Technical, Quality-of-Life, and Aesthetics Outcomes

Abstract

Introduction: Reduction mammaplasty is a mainstay in the treatment of symptomatic macromastia, with a well-described positive impact on patient quality-of-life (QoL). Absorbable dermal staplers have the potential to improve the efficiency of skin closure in reduction mammoplasties, but a more comprehensive assessment of its impact on key outcomes has not been fully elucidated. Methods: A retrospective review of patients undergoing reduction mammoplasty between November 2018 and December 2020 was conducted. Patients were included if they had undergone a wise-pattern reduction with a superomedial pedicle and completed 3 months of follow-up. Patient demographics, operative information, clinical and aesthetic outcomes, and QoL were compared between patients that had INSORB stapler-assisted and suture-only closures. Results: Seventy-five patients met the inclusion criteria, with 34 patients (45%) in the stapler cohort. Total procedure time was significantly reduced with the use of the dermal stapler (stapler: 154 vs. suture: 170 minutes; p = 0.003). The incidence of major complications was similar between cohorts (stapler: 8.8% vs. suture: 12%; p = 0.64), as was the incidence of minor complications (stapler: 44% vs. suture: 41%; p = 0.82). Regardless of closure technique, patients demonstrated significant increases in all QoL domains (p <0.001). Lastly, 10 independent raters found no difference in the cosmetic appearance of breasts from either cohort, when judging overall breast appearance, shape, scars, volume and the nipple-areolar complex (all p > 0.05). Conclusions:The dermal stapler improves efficiency of closure during reduction mammoplasty without increasing the incidence of wound healing complications. Additionally, cosmetic outcomes are not affected, and patients demonstrate similar post-operative satisfaction with the result regardless of closure technique.

Use of Absorbable Dermal Staples in Bilateral Breast Reduction Surgery

“…Our work demonstrates a significant reduction in operative time with the use of absorbable deep dermal staplers. This conclusion, involving both inferior and superior pedicle procedures, is largely aligned with other studies that have indicated faster closure times with dermal staples without sacrifice to aesthetic or functional outcomes 8–12,17 . Type of pedicle was not implicated as a significant predictor of changes in operative time, indicating that this trend is similar with both inferior and superior pedicles during reduction mammaplasty.…”

“…This conclusion, involving both inferior and superior pedicle procedures, is largely aligned with other studies that have indicated faster closure times with dermal staples without sacrifice to aesthetic or functional outcomes. [8][9][10][11][12]17 Type of pedicle was not implicated as a significant predictor of changes in operative time, indicating that this trend is similar with both inferior and superior pedicles during reduction mammaplasty. In context of increasing demand for reconstructive procedures, 18 reductions in operative time are favorable for optimizing workflow for surgeons and their teams.…”

“…A previous study provided evidence that absorbable dermal staple closures in breast reductions with superomedial pedicles were associated with equal improvements to quality of life and rate of postoperative complications when compared with dermal suture closures after reduction mammaplasty. 12 However, the superomedial pedicle represents only one approach in reduction mammaplasty and involves differences in technique, outcomes, and prevalence when compared with other approaches, such as inferior and superior pedicles. [13][14][15] These potential differences motivate a further exploration of the application of absorbable dermal staples during wound closure.…”

“…Despite the increases in operative efficiency associated with dermal staples, the differences in outcomes between dermal staples and conventional sutures in reduction mammaplasty closures have not been fully elucidated. A previous study provided evidence that absorbable dermal staple closures in breast reductions with superomedial pedicles were associated with equal improvements to quality of life and rate of postoperative complications when compared with dermal suture closures after reduction mammaplasty 12 . However, the superomedial pedicle represents only one approach in reduction mammaplasty and involves differences in technique, outcomes, and prevalence when compared with other approaches, such as inferior and superior pedicles 13–15 .…”

The Learning Curve of an Absorbable Subcuticular Stapling Device in Plastic and Reconstructive Surgery

“…This device is very familiar in our field, and the efficacy of this device is well established. 1 Within cosmetic surgery, the use of this device has been established in breast and facial rejuvenation, [2][3][4] and within reconstructive procedures, it has been proved effective for efficient closure of donor sites. 5 The application of this device extends to other surgical specialties mainly in obstetric, general, and orthopedic cases.…”