Efficacy and Safety of Barbed Sutures for Capsulorrhaphy in Implant-Based Breast Reconstruction

Background: A common postoperative challenge following implant-based breast reconstruction surgery is lateral or inferior displacement of the implant, which ultimately requires surgical intervention to shape the pocket for improved symmetry. Capsulorrhaphy is traditionally performed with smooth sutures, but the use of barbed sutures has proven to be more efficient and effective in other plastic surgery procedures. This study aimed to demonstrate the safety and efficacy of barbed sutures for breast reconstruction implant capsulorrhaphy.

Methods: A retrospective cohort study was performed including all consecutive patients who underwent capsulorrhaphy by the senior author utilizing barbed sutures and, for comparison, another colleague utilizing smooth sutures from the years 2018-2021.

Results: Twenty-eight patients were identified who underwent barbed suture capsulorrhaphy (a total of 36 breasts operated on), which was compared with 20 patients who had smooth suture capsulorrhaphy (a total of 34 breasts operated on). The average ages of the barbed and smooth suture cohorts were 55 and 53 years old (P = 1.00), respectively. The average BMI of the barbed and smooth suture cohorts were 26.7 and 25.0 kg/m² (P = .15), respectively. The reoperation rates for both groups were similar at 5%. Overall complication rate was 13.9% in the barbed suture group and 8.8% in the smooth suture group, which was not statistically significant (P = .71). Patients with barbed sutures did not have an increased risk of complications compared with those who received smooth sutures (OR 1.67 (0.37-7.59), P = .51).

Conclusions: In conclusion, performing implant-based breast reconstruction capsulorrhaphy with barbed sutures is a safe and effective procedure as compared with smooth sutures.