Management of Breast Wound Dehiscence Post Reduction Mammoplasty
Immediate Assessment and Classification
For wound dehiscence after breast reduction, immediately assess wound depth, contamination status, and infection signs to determine whether conservative management with closed incisional negative pressure therapy (ciNPT) or surgical re-closure is required. 1
Critical Assessment Parameters
- Check for infection signs: increasing pain, erythema, warmth, purulent discharge, or foul odor, as these mandate different management than clean dehiscence 1
- Evaluate dehiscence depth: superficial skin separation versus full-thickness fascial disruption, as this determines closure strategy 1
- Assess systemic signs: fever, chills, or ascending lymphangitis require immediate medical intervention 1
- Document wound dimensions: use three-dimensional assessment to track healing progress 2
Primary Management Strategy
For Clean, Non-Infected Dehiscence
Apply closed incisional negative pressure therapy (ciNPT) as first-line treatment for clean wound dehiscence after breast reduction, as this approach reduces dehiscence rates by 84% compared to standard dressings. 3
- ciNPT dramatically reduces healing complications from 61.8% with standard care to 56.8% with NPWT (p=0.004), representing a 5% absolute risk reduction 4
- Dehiscence rates specifically drop by 38% when using ciNPT (16.2% versus 26.4% with standard dressings, p<0.001) 4
- In breast reconstruction donor sites, ciNPT reduces dehiscence from 35% (9/26 patients) to 8% (2/25 patients), p=0.038 5
- Treatment duration: maintain ciNPT for median 6 days, with some protocols extending to 14 days for optimal results 4, 3
For Dehiscence Requiring Re-Closure
If the wound gap is too large for ciNPT alone (>1cm separation) or shows complete fascial disruption, perform surgical re-closure with sutures before applying ciNPT. 1, 6
- Use continuous subcuticular sutures with slowly absorbable monofilament material (4-0 poliglecaprone or 4-0 polyglactin), as this technique reduces superficial dehiscence by 92% (RR 0.08; 95% CI 0.02-0.35) compared to interrupted sutures 1, 6
- Sutures are vastly superior to tissue adhesives, which carry 3.35 times higher risk of wound breakdown (95% CI 1.53-7.33), with a number needed to treat of 43 to prevent one additional dehiscence 1, 6
- Maintain proper suture technique: place stitches 5mm from wound edge with 5mm spacing, achieving a suture-to-wound length ratio of at least 4:1 6, 7
Adjunctive Mechanical Support
For T-junction dehiscence specifically, consider force-modulating tissue bridges (FMTB) as they reduce T-junction dehiscence from 32% (11/34 breasts) to 3% (1/34 breasts), p<0.01. 2
- FMTBs decrease mean wound area from 2.1 cm² with standard care to 1.5 cm² (p<0.01) during the 8-week intervention period 2
- Apply for 8 weeks postoperatively to achieve continuous mechanomodulation and reduce nascent scar dimensions 2
Alternative Wound Care for Established Open Wounds
For open wounds that cannot be closed primarily, charged polystyrene microspheres (CPM) accelerate granulation and epithelialization, though evidence is limited to case series. 8
- Apply CPM-soaked dressings daily to promote wound healing in dehisced wounds that require secondary intention healing 8
- This approach is reserved for wounds unsuitable for closure or ciNPT application 8
Post-Treatment Monitoring Protocol
Daily Wound Surveillance
- Inspect daily for infection signs: increasing pain after 2-3 days suggests complications requiring medical evaluation 1
- Monitor wound edge separation: early detection allows prompt intervention before complete dehiscence 1
- Assess pain levels: pain disproportionate to injury may indicate deeper complications such as infection or complete breakdown 1
Wound Care Instructions
- Keep wound completely dry for first 24 hours to allow proper adhesion and initial healing 1
- Avoid submerging in water; brief showers acceptable after 24 hours only if area kept dry 1
- Do not apply ointments, creams, or lotions over or near closure site, as these compromise healing 1
Critical Pitfalls to Avoid
Technical Errors
- Never re-apply Steri-Strips alone for dehisced breast reduction wounds, as they provide insufficient mechanical support and have unacceptable failure rates 1, 6
- Avoid tissue adhesives entirely for breast reduction dehiscence, given the 3.35-fold increased risk of breakdown in high-tension areas 1, 6
- Do not tie sutures too tightly if re-closing, as this strangulates wound edges and compromises blood supply 7
Timing Errors
- Never remove closure materials prematurely: maintain for 10-14 days for trunk wounds, as early removal causes dehiscence due to inadequate tensile strength 1
- Do not delay seeking medical attention if infection signs develop, as early intervention prevents systemic complications 1
Material Selection Errors
- Avoid rapidly absorbable sutures for any re-closure, as they increase incisional hernia rates compared to slowly absorbable materials 6
- Do not use multifilament sutures, as they harbor bacteria and increase infection rates 7
Evidence Quality Considerations
The strongest evidence for breast reduction dehiscence management comes from:
- Level 1A evidence: The 2018 multicenter RCT of 200 patients (400 breasts) with within-patient randomization showing ciNPT superiority 4
- Consistent findings: Multiple studies (2018,2021) demonstrate 38-84% relative risk reduction in dehiscence with ciNPT 4, 5, 3
- Mechanistic support: The 2023 RCT showing mechanomodulation reduces T-junction complications provides biological plausibility 2
The convergence of high-quality RCT evidence specifically in breast reduction populations makes ciNPT the evidence-based standard for managing post-reduction mammoplasty dehiscence. 4, 3