Background
Central excision for cancers and benign problems involving or behind the nipple–areola complex (NAC) can lead to loss of breast projection. Tissue transfer and mammoplasty techniques can be used to correct this in larger breasts. We present a simple method that is particularly useful in smaller breasts.
Technique
Following central breast excision, a circumferential purse string suture is first placed deeply around the base of the defect, taking adequate bites of tissue to prevent ‘cutting out’. Once this suture has been pulled tight and knotted, a second identical, superficial suture is placed and tied (Fig 1). Our preferred suture material has been 3/0 Vicryl® (Ethicon, Somerville, NJ, US). The overlying skin can then be mobilised and closed in the usual way, in this case using an absorbable subcuticular stitch (Fig 2).
Figure 1.
Second suture being tied
Figure 2.
Closure of overlying skin using an absorbable subcuticular stitch
Discussion
Purse string closure is a recognised technique for closing fairly large, rounded skin defects, particularly after wide excision for melanoma.1,2 It has also been described for skin closure after central breast excision (‘NACectomy’). Our preference is to use this method centrally to close the underlying breast parenchyma so as to restore breast projection and contour. Although particularly advantageous after central excision, the method can be useful in closing defects elsewhere in the breast with relatively little tethering or distortion.
References
- 1. Cohen PR, Martinelli PT, Schulze KE, Nelson BR. The cuticular purse string suture: a modified purse string suture for the partial closure of round postoperative wounds. Int J Dermatol 2007; 46: 746–753. [DOI] [PubMed] [Google Scholar]
- 2. Lin H, Li W. Complete closure using a double purse-string closure for skin defects. Dermatol Surg 2009; 35: 1,406–1,409. [DOI] [PubMed] [Google Scholar]