Enhancing Flap Breast Reconstruction with the Percutaneous Purse-String Suture and Fat Grafting

Introduction: Reconstructing the inframammary fold (IMF) in breast reconstruction is essential to obtain natural results. Lipofilling is a safe and valuable option in breast reconstruction, but often fails to provide sufficient projection and inframammary fold definition. The percutaneous purse-string suture can be used in adjunct to lipofilling or other breast surgery to improve breast projection and inframammary fold definition. Methods: After the lipofilling procedure the position of the desired breast footprint and IMF is defined. A PDS resorbable suture is introduced around the breast footprint with the use of a lipofilling cannula through small stab incisions. One suture is placed in a superficial subcutaneous plane and a second suture is placed in a deep subfascial plane to provide sufficient suspension in different tissue planes. The breast projection improves as a result of the forward bulge in the fat graft, which is confined within the new breast footprint. Conclusion: The use of the percutaneous purse-string suture is a valuable adjuvant technique that provides improved projection and IMF definition in various types of breast surgery.