If Gore-Tex Sutures Are Used in Breast Reduction Surgery, Will the Areola Not Stretch?

In breast reduction surgery,

scars are unavoidable.

Scars can be divided into

the areolar, vertical, and inframammary

three types of scars.

Among these, the one that requires the most attention

is the 'areolar scar.'

So, let’s look at how to make the scar in this areolar area

fade as much as possible.

To reduce scarring,

it is of course important to suture well.

But to suture well,

conditions that are favorable for closure

must be created.

The most important condition is

that the lengths on both sides being sutured

must be similar.

If one side is longer or shorter,

creating a difference in the length of the two sides,

it becomes wrinkled.

However, in the areolar incision method

or vertical incision method,

a characteristic is that the diameter of the surrounding skin

is designed to be larger than the diameter of the areola.

In such cases, the surrounding skin is pulled in,

and when it is sutured together around the areola

as if drawing a pouch closed, wrinkled folds remain

like the opening of a money pouch.

These wrinkles do not disappear on their own.

They fade as the difference in diameter between the areola and the surrounding skin

gradually decreases due to areolar skin expansion.

As the surrounding skin that had been pulled inward returns

to its original position,

the wrinkles gradually smooth out,

but the diameter of the areola also gradually increases.

In addition, because the outer part of the breast is heavier than the inner part,

it often forms an unsatisfactory shape,

large and drooping like a panda’s eye.

Disappointed by these results,

doctors tried various methods

to prevent the areola from stretching.

The first method that became popular was

to gather the skin around the areola with

non-absorbable nylon thread and secure it in place.

Like drawing the opening of a money pouch closed,

the surrounding skin was pulled toward the areola

and then permanently tied in place with non-absorbable nylon thread.

This method is called the 'pouch suture method.'

However, in the long term,

it was impossible to fix soft skin with a hard thread.

Non-absorbable nylon thread can maintain a certain diameter inside the skin,

but the dark areola gradually stretches as it passes over this thread,

and eventually the nylon thread remains inside the widened areola.

This phenomenon occurs.

This phenomenon is called the 'cheese-wiring phenomenon.'

The hard thread acts like a knife,

cutting through soft cheese with a wire

and burrowing into the widening areola.

When this pouch suture method using nylon thread

was proven to be a failure,

a new method appeared.

Instead of using hard nylon thread,

it uses 'Gore-Tex thread,' which has elasticity

and also adheres to tissue.

Because Gore-Tex is mainly used in cardiovascular surgery,

it can also give the impression of being a very good material.

However, Gore-Tex is ultimately a product made by

heating plastic fabric and stretching it out

to create microscopic pores.

In medical Gore-Tex products,

body tissue proliferates into these microscopic pores,

creating adhesion,

so they are also used as implants

or artificial blood vessels.

In this respect, if Gore-Tex thread is used

when closing the skin around the areola inward,

the scar tissue grows into the inside of the Gore-Tex thread,

preventing the cheese-wiring phenomenon

and suppressing areolar expansion.

However, this method also could not improve the problem.

The reason was that Gore-Tex undergoes a hardening effect

when it remains in the human body for a long period of time.

In the end, like nylon thread, it hardens,

and the areola expands past the Gore-Tex thread.

In fact, looking at the long-term surgical results

of the areolar incision method using Gore-Tex thread,

it is common to see the Gore-Tex thread

burrowing into the widened areola.

In conclusion, contrary to expectations,

the wrinkles around the areola do not spread on their own

without a cost.

The reason the wrinkles in the surrounding skin

gradually smooth out

is because of areolar expansion.

Theoretically, if the areola

does not stretch at all,

then as the price to pay,

the surrounding wrinkles would remain permanently.

If suturing is done with the skin diameter

larger than the areolar diameter,

wrinkles inevitably form,

and these wrinkles do not disappear on their own.

They fade only as the areola gradually stretches and expands,

reducing the difference in length between the two sutured sides.

And it is difficult for any new thread to prevent this phenomenon.

There is a tendency to trust new materials blindly,

but in the medical field,

technology is applied with human lives at stake,

so I believe it is right to be more conservative

than in any other field when adopting something new.

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