Tissue adhesives versus traditional sutures in breast surgery: A systematic review and meta-analysis
Rajeh Ruzayqat, Ahmed Harb, Lina K. Al Jabry, Ahmed Mohamed Elkhouly, Ahmed Hany Harfoush, Arun Kumar Maloth, Nihal BabikerBackground
In breast surgery, closure methods influence operative efficiency, wound healing, and cosmetic outcomes. Tissue adhesives have emerged as an alternative to sutures, yet their overall effectiveness remains uncertain.
Methods
This systematic review and meta-analysis followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420251060295). PubMed, Scopus, Web of Science, and Embase were searched without restrictions. Eligible studies compared tissue adhesives with sutures in breast surgery. Primary outcomes included wound complications (infection, dehiscence, seroma, hematoma). Secondary outcomes were pain, closure time, and patient satisfaction. Risk of bias was assessed using RoB 2 and ROBINS-I, and certainty of evidence was graded with GRADE. Random-effects models were used for pooled analyses.
Results
Eleven studies with 745 patients were included. In an independent-groups analysis excluding two split-body-design studies, tissue adhesives were associated with shorter closure time compared with sutures (mean difference = −2.60 minutes, 95% CI –3.54 to −1.67), though heterogeneity remained high (I 2 = 86.0%) and certainty of evidence was very low; two additional split-body-design studies were evaluated narratively and were not pooled with this estimate. No significant differences were observed in infection, dehiscence, hematoma, seroma formation, or postoperative pain. An exploratory subgroup analysis, based on only two studies, suggested a possible increased infection risk when adhesive was used for flap fixation rather than skin closure; this difference was not statistically significant. Overall certainty of evidence ranged from low to very low due to methodological limitations and heterogeneity.
Conclusions
Tissue adhesives were associated with shorter closure time, though this finding carries very low certainty, and no statistically significant differences were detected for other outcomes. Their use may be most appropriate in superficial closures and cosmetic procedures; an exploratory signal of increased infection risk was noted specifically for adhesive-assisted flap fixation and should not be generalized to deep wound closure broadly. Larger, high-quality randomized trials with standardized outcome reporting are needed to clarify their role in clinical practice.