Barbed Ribbon Device for Progressive Tension Closure Reduces Seroma After Breast Reconstruction

Abstract

Purpose: Implant-based breast reconstruction is fraught with complications related to seroma formation. Soft tissue stabilization with progressive tension closure (PTC) has been shown to decrease seroma formation after various procedures but is less suitable for mastectomy flap stabilization. We evaluate the incidence of seroma in breast reconstruction using bioabsorbable barbed ribbon devices (BRDs) as a novel approach to PTC.

Methods: We performed a retrospective review of all patients whose mastectomy flaps were stabilized with BRDs. These patients were compared with consecutive patients who underwent mastectomy and reconstruction without progressive tension flap stabilization. Patient demographics and outcomes were recorded, including comorbidities, complications, presence of seroma, and total drain days.

Results: In the BRD-PTC group, there were 36 breasts compared with 56 in the nonstabilized control group. There were no significant differences in rate of tobacco use, age, or body mass index. We identified 11 seromas in the control group (19.6%) and none in the intervention group (P = 0.05). In the PTC group, drains were removed an average of 5 days sooner than those in controls (P = 0.006).

Conclusion: Progressive tension stabilization of mastectomy flaps with BRD significantly reduces seroma formation and the duration for which closed suction drainage is required.

FIGURE 1

Photograph of bioabsorbable BRD illustrating flexibility and tine dimensions.

FIGURE 2

Preoperative marking for circumvertical mastectomy.

FIGURE 3

Tissue expander reconstruction of circumvertical mastectomy with ADM. Lateral flap falls away from midline.

FIGURE 4

Barbed ribbon device is easily secured to ADM with 3 interrupted sutures.

FIGURE 5

Tines are oriented to midsagittal axis of breast and placed 2 to 3 cm apart allowing for maximum adherence of mastectomy flap to underlying muscle and ADM.

FIGURE 6

Lateral breast flap falls away from midsagittal breast axis before securement (left). Flap closed in a progressive tension fashion with BRDs before placement of any sutures (right).

FIGURE 7

Final mastectomy flap progressive-tension stabilization to ADM with BRDs. Tines from opposing ribbons are oriented to midsagittal breast. Flap is secure in “progressive-tension” fashion without puckering, contour deformity, or flap ischemia. Drains are placed per routine and incision is closed in a typical fashion.