Superior Pedicle Mastopexy Suturing Technique
The superior pedicle in mastopexy is typically secured using interrupted non-absorbable sutures in a layered fashion to anchor the glandular tissue and create internal support, though the specific technique varies based on whether mesh reinforcement is used.
Standard Suturing Approach
For the superior pedicle itself, the breast tissue is elevated on a superior dermal pedicle and then transposed into position, with the glandular tissue shaped and secured using internal sutures 1. The key is creating a stable internal breast support system that maintains projection and upper pole fullness.
Layered Closure Technique
When closing the breast envelope after superior pedicle elevation:
- Deep layer: The glandular tissue is approximated using absorbable sutures to shape the breast mound and secure the pedicle position
- Dermal layer: Interrupted or continuous subcuticular sutures close the deepithelialized skin flaps
- Skin closure: Subcuticular continuous sutures are preferred over interrupted sutures, as they reduce superficial wound dehiscence (RR 0.08; 95% CI 0.02 to 0.35) 2
Use 4-0 poliglecaprone or 4-0 polyglactin for subcuticular continuous closure, as these materials retain 50-75% tensile strength after one week, providing extended wound support 2.
Mesh Reinforcement Technique (When Used)
When surgeons opt to reconstruct an internal breast support system with biocompatible mesh to replace the ligamentous suspension:
- The mesh is sutured to create a supportive "brassiere" around the shaped glandular tissue 3
- Non-absorbable sutures (2-0 or 1-0 monofilament or braided) are used in interrupted fashion to secure the mesh 4
- The mesh provides a flat surface and prevents recurrent ptosis by replacing the failed ligamentous suspension 3
Dermal Suspension Modification
A newer approach uses dermal suspension flaps that wrap around the central gland like a brassiere after peripheral resection 5. This involves:
- Creating deepithelialized dermal flaps from the resected tissue
- Suturing these flaps to wrap and support the shaped glandular tissue
- This provides glandular shaping, better longevity, and tensionless skin closure 5
Critical Technical Points
Avoid excessive tension on suture lines - this is a common pitfall that leads to wound complications and poor scarring. The internal glandular shaping and support should bear the weight, not the skin closure 5, 6.
The horizontal flap technique can be used where the superior pedicle is fashioned into a horizontal flap that sits in the inframammary fold, creating a protective stabilizing brace 6. This decreases tension and protects any implants if used concurrently.
Suture Material Selection
- Skin closure: Absorbable subcuticular continuous (4-0 poliglecaprone or polyglactin) 2
- Mesh fixation (if used): Non-absorbable 2-0 or 1-0 interrupted 4
- Glandular shaping: Absorbable interrupted sutures (surgeon preference on caliber)
The evidence strongly supports continuous subcuticular closure over interrupted transcutaneous sutures for the final skin layer, as this significantly reduces wound dehiscence without increasing infection risk 2.