PURPOSE: DERMABOND has been available as a skin closure alternative or adjunct for a variety of skin closures since 1997. Skin closures with DERMABOND have been shown in other areas to be equivalent to sutured closures with respect to healing potential, wound strength and cosmesis. The purpose of this study is to review a large series of 255 consecutive bilateral reduction mammaplasty patients (510 breasts) to evlauate the safety and efficacy of DERMABOND for these procedures. METHODS: A retrospective review was undertaken of 255 consecutive patients (510 breasts) undergoing primary bilateral reduction mammaplasty for the relief of symptomatic macromastia by a single surgeon from 1999-2005. Since 1999 all breast reduction incisions have been closed with interrupted, buried, intradermal sutures of 3-0 Monocryl followed by application of DERMABOND to seal the skin edges. An inferior pedicle, "inverted T" technique using a Wise pattern was used for all patients. The patients' medical records were reviewed to obtain formation including age, bra cup size (pre-op and post-op), resection weights (grams/breast), and operative times. Postoperative results including nipple sensation, relief of symptoms, and satisfaction with results were noted. Complications including delayed wound healing, hypertrophic scar revisions, cellulitis, and wound dehiscence (minor and major) were noted. Comparisons were made to an earlier series by the same surgeon using the sutured skin closure technique. Patients were instructed to resume showering or bathing and apply antibiotic ointment to their incisions to remove the DERMABOND remnants at about the seventh postoperative day. RESULTS: The average age of patients in the reviw was 41 years with a range of 15-73 years. The most common preoperative bra cup size was "DD" (52%), folowed by "DDD" (20%), "D" (18%), and "E and greater" (10%). Postoperatively the most comon bra cup size was "C" (60%) followed by "B" (21%), and "D" (19%). The average resection per breast was 605 grams with a range of 174-1684 grams. The average operative time (incision to closure) was 93 minutes with a range of 50-130 minutes. All surgeries were performed as outpatient procedures. The overall complication rate was 15%. Delayed wound healing, usually in the area of the "inverted T", occurred in 15 patients (6%). These wounds healed uneventfully with local care. Hypertrophic scar revisions were performed in 13 patients (5%). Cellulitis resolving with p.o. antibiotic therapy occurred in 7 patients (3%). Minor wound dehiscences requiring non suture reclosure (steri-strps) occurred in 3 patients (1.1%). and major wound dehiscences requiring a sutured reclosure occurred in 2 patients (0.8%). Two patients required liposuction for postoperative asymmetry, one patient required surgical correction of medial "synmastia", and one patient developed unilateral skin flap necrosis which healed secondarily. Patients reported "good to normal" nipple sensation in 86% of cases. Unilateral diminished nipple sensation was reported in 14% of patients. No patient reported complete loss of nipple sensation. The majority of patients (98%) reported relief of their preoperative symptoms and satisfaction with their results. In the author's previous review of bilateral reduction mammaplasties with sutured skin closures, the rate of minor wound complications was 20% and unilateral diminished nipple sensation occurred in 13% of patients. The previous operative time averaged 116 minutes. CONCLUSIONS: The use of DERMABOND for skin closures in bilateral reduction mammaplasty is safe and effective. Complication rates involving wound healing are comparable to sutured skin closures. The ease and speed of application contributes to shortened operative times (23 minutes or 20% less time). Patient postoperative discomfort is minimized since only simple gauze dressings are needed, no surgical skin tapes are used, there are no sutures to remove, and showering or bathing can be resumed within the first week following surgery.
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