What type of sutures are recommended for use in Modified Radical Mastectomy (MRM)?

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Last updated: September 23, 2025 • View editorial policy

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Suture Recommendations for Modified Radical Mastectomy

For modified radical mastectomy procedures, triclosan-coated absorbable sutures like polyglactin 910 (Vicryl) are recommended for optimal outcomes with reduced surgical site infection risk. 1

Suture Selection by Tissue Layer

Skin Closure

  • Recommended: Subcuticular closure with absorbable sutures
    • Preferred material: 5-0 coated polyglactin 910 (Vicryl) or poliglecaprone 25 (Monocryl)
    • Subcuticular technique provides superior cosmetic results 1
    • Triclosan-coated versions (e.g., Vicryl Plus) show better cosmetic outcomes and potentially lower infection rates 2

Deep Tissue/Fascial Closure

  • Recommended: Triclosan-coated absorbable sutures
    • Material: 2-0 or 3-0 polyglactin 910 (Vicryl Plus)
    • Evidence shows significant reduction in surgical site infection prevalence compared to non-coated sutures 1

Subcutaneous Tissue

  • Recommended: 3-0 or 4-0 absorbable sutures
    • Material: Polyglactin 910 (Vicryl) or poliglecaprone 25 (Monocryl)
    • Monofilament options (Monocryl) cause less bacterial seeding 3, 4

Evidence-Based Rationale

Infection Prevention

Triclosan-coated sutures significantly reduce surgical site infection risk compared to non-coated alternatives 1. A meta-analysis of 18 studies with 7,458 patients demonstrated that antimicrobial sutures reduced SSI risk (OR 0.72,95% CI 0.59–0.88, P = 0.001) 1.

Cosmetic Outcomes

Subcuticular closure technique is preferred for optimal cosmetic results 1. Research comparing polyglactin 910 (Vicryl) with Chinese silk sutures in breast cancer surgery demonstrated significantly better cosmetic outcomes with Vicryl (mean VAS score 67.2 vs 45.4, p<0.0001) 2.

Wound Healing Benefits

Absorbable sutures like polyglactin 910 (Vicryl) maintain approximately 50-75% of their tensile strength after 1 week in situ, providing extended support during critical wound healing periods 1, 3. This extended support helps prevent wound dehiscence compared to rapidly absorbing alternatives or non-absorbable sutures that require removal after 7-9 days 3.

Technical Considerations

  • Meticulous hemostasis is critical to prevent hematoma formation 1
  • Avoid drains in the breast when possible 1
  • Specimen orientation by the surgeon with sutures, clips, or indelible ink is important 1
  • Preservation of subcutaneous tissue with separate closure improves cosmetic results 1

Specific Suture Properties

Polyglactin 910 (Vicryl)

  • Braided, multifilament suture
  • Complete absorption: 60-90 days
  • Maintains 50-75% tensile strength after 1 week 3
  • Available with triclosan coating (Vicryl Plus) for antimicrobial properties

Poliglecaprone 25 (Monocryl)

  • Monofilament suture with excellent handling properties
  • Complete absorption: 91-119 days 5
  • Provides 20-30% breaking strength retention after 2 weeks 5
  • Causes minimal tissue drag and resistance during passage through tissue

Common Pitfalls to Avoid

  1. Avoid excessive tissue tension - Reapproximation that appears adequate with the patient supine often results in distortion when the patient is upright 1

  2. Avoid periareolar incisions for lesions in the periphery - These are inappropriate and can lead to poor cosmetic outcomes 1

  3. Don't section specimens before submission to pathology - This practice may compromise accurate evaluation of surgical margins 1

  4. Avoid non-coated sutures when antimicrobial options are available - Evidence strongly supports the infection-reducing benefits of triclosan-coated sutures 1

  5. Don't use immediate reconstruction - Until larger studies are conducted, immediate reconstruction after MRM is not recommended 1

By following these evidence-based suture recommendations for modified radical mastectomy, surgeons can optimize wound healing, minimize infection risk, and achieve superior cosmetic outcomes.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Guideline

Absorbable Sutures

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

4
Research

The Surgical Suture.

Aesthetic surgery journal, 2019

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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