Is it better to leave a small open area on a breast lift patient's lateral incision open with wound healing gauze or use Steri-Strips (adhesive strips) to close it?

Wound Management for Breast Lift Lateral Incision Dehiscence

Use Steri-Strips to close the small open area on your breast lift patient's lateral incision rather than leaving it open with wound healing gauze. While evidence shows Steri-Strips don't reduce surgical site infection rates, they provide mechanical support for wound approximation without the risks associated with leaving wounds open, and breast surgery guidelines specifically recommend subcuticular closure techniques for optimal cosmesis 1.

Rationale for Steri-Strip Application

Evidence Supporting Closure Over Open Management

• Delayed primary closure (leaving wounds open) is primarily indicated for contaminated abdominal surgeries and high-risk SSI patients—not for clean aesthetic breast procedures 1.

• Breast conservation surgery guidelines emphasize that skin should be closed with subcuticular techniques to optimize cosmetic outcomes, and when small dehiscences occur, approximation is preferred over leaving defects open 1.

• Steri-Strips provide painless, low-tension wound approximation that is particularly useful for wounds requiring gentle closure to minimize scarring 2.

Why Not Leave It Open

• Open wound management increases the risk of:

  • Prolonged healing time with increased scarring 3
  • Greater wound care burden and patient discomfort 3
  • Potential for larger defects as wound edges retract 1

• The breast has excellent blood supply which supports rapid healing when edges are approximated, making closure more favorable than open management 2.

Practical Application Guidelines

Steri-Strip Technique

• Ensure the wound edges are clean and dry before applying Steri-Strips to maximize adhesion 4, 2.

• Apply strips perpendicular to the incision line to provide optimal mechanical support for wound edge approximation 2.

• Leave Steri-Strips in place for 5-7 days for facial wounds, though breast incisions may benefit from slightly longer duration (7-10 days) given moderate tension 2.

Monitoring and Follow-up

• Assess for signs of infection including increasing pain, redness, swelling, or discharge during the healing period 4.

• Pain disproportionate to the wound severity may indicate deeper complications such as hematoma or infection requiring intervention 4.

• Meticulous hemostasis is critical in breast surgery as hematoma formation produces changes difficult to interpret and may lead to unnecessary future biopsies 1.

Important Caveats

When Open Management Might Be Considered

• If there is active infection or purulent drainage, the wound should be opened, debrided, and managed with appropriate wound care until infection clears 5.

• If significant tension exists that would cause Steri-Strips to fail or pull through tissue, consider formal suture closure rather than either Steri-Strips or open management 1.

Adjunctive Measures

• Consider negative-pressure wound therapy (NPWT) for high-risk wounds if the patient has risk factors for wound complications, though this is typically reserved for more extensive dehiscences 1.

• Avoid drains in the breast tissue as they can compromise cosmetic outcomes and increase infection risk 1.

• Do not reapproximate deep breast tissue in most cases, as this often leads to distortion when the patient is upright and mobile 1.