Subcuticular suture gathered

Fig. 7.7. Interrupted buried 3-0 Monocryl sutures are used in the deep dermis. The skin is closed with a subcuticular 3-0 Monocryl. I now use less gathering with this suture. Not only does it take the pucker longer to settle, but the vertical skin stretches out with time despite the gathering. If the skin has poor elasticity, then some gathering may be indicated, but only at the inferior aspect of the vertical incision. Excess gathering caused a tear-drop-shaped areola in the initial postoperative stages, and it could constrict the blood supply to the skin, causing wound-healing problems at the skin edges. Care must be taken not to take deep constricting bites of dermis when this suture is gathered

Only a few sutures of 3-0 Monocryl are used to bring the pillars together. These sutures are not large, and only solid breast tissue, not fat, is brought together. These sutures need only be strong enough to hold the breast tissue together until the normal healing process takes over.

Skin Closure

Deep Dermal Closure

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