Can Stitches on Muscle Repair Be Torn by Coughing?

Abdominoplasty
not only removes excess skin, but also tightens the underlying abdominal wall
muscles.These muscles can be weakened,
stretched and torn during pregnancy.This can result in the characteristic protuberant abdomen that is
commonly seen following pregnancy.Abdominoplasty tightens these
muscles in a side to side manner which results in a flatter abdomen.Most surgeons use a continuous suture for
this closure, but in some cases individual sutures may be used instead.These sutures maintain the structural
integrity of the abdominal wall until the wound has regained adequate
strength.This usually occurs in about 6
to 8 weeks.At this point, these
structural sutures have served their purpose.When trauma of any type occurs
during the initial phases of wound healing, disruption of these sutures can
result in a recurrence of the original problem.Under these circumstances, a flat abdominal wall may suddenly bulge in
an outward direction.Although it’s
unlikely that coughing could cause this type of problem, it’s still definitely
a possibility.If you’re concerned about disruption
of your internal sutures, a consultation with your plastic surgeon is
appropriate.Your surgeon should be able
to evaluate your abdominal wall and determine whether or not a disruption of
your closure has occurred.

It is within the realm of possibility that you could have popped a suture, but with that being said, it is highly unlikely. Board Certified Plastic Surgeons are very particular when suturing the abdominal wall. I would still seek the guidance of your plastic surgeon.

Yes, severe coughing could theoretically disrupt an abdominal rectus diastasis muscle repair. For this reason, the use of a binder can be helpful.

Anything is possible but not everything is likely.  When we repair the muscles during a tummy tuck,. the muscles are actually not sutured.  Instead, the tissue around the muscles (called "fascia") is brought together and so any disruption of the repair would actually involve this tissue.

And although the sutures could potentially cheese-wire through this tissue, it is very unlikely.  However, I would definitely contact your Plastic Surgeon and let them know your concerns.  A good physical exam may be able to answer your question and give you peace of mind.

I hope that helps!

I am sorry to hear about your concerns after tummy tuck surgery.For precise diagnosis and advise you will be best served by visiting with your plastic surgeon.Generally speaking the plication of the abdominal wall is very secure and it would take significant force / trauma to disrupt this repair. Generally speaking, a sneeze, cough and/or straining will not generate enough force to harm the repair.Again, if you are concerned, I would suggest that you visit with your surgeon for an examination so that he/she can (most likely) put your mind at ease. It will also be important to determine the cause of your persistent cough ( rule out pulmonary complications such as pneumonia). Best wishes.

It is possible to damage the muscle tightening from severe coughing, vomiting, straining - activities that can increase intraabdominal pressures.  That is why plastic surgeons recommend no heavy lifting or strenuous activity after surgery for 4-6 weeks.  However, most of the time, multiple sutures are placed. So even if you heard a pop, you likely have back up sutures.  Please see your plastic surgeon for an evaluation.

Thanks for the question.

It is possible that increased intra-abdominal pressure, either caused by coughing, or possibly vomiting, could cause a muscle tear along the repair line, but this would be highly unlikely, especially in a sound repair.  To be certain, follow-up with your surgeon for a thorough examination.

Warmest Regards,

Glenn Vallecillos, MD, FACS

Putting the 6 pack (Rectus) tummy muscles together and keeping them together while healing is the single most important factor determining tummy flatness. If muscle repair is avoided (when needed) - the tummy will not be flat and IF the muscle repar fails (breaking stitches) - the tummy pooch will re-appear.
The likelihood of muscle repair stitch breakage depens on HOW the muscles were brought together by your surgeon ( type of stitches (dissolving Vs permanent), configuration of stitches (single interrupted or a running stitch), numbers of layers of stitches), the quality of your muscle fascia (good thickness or thin and less apt to "hold" a stitch), your propensity to suddenly increase outgoing intraabdominal pressure (Valsalva) (as is severe coughing, vomiting, wrenching, straining etc).
Unfortunately, severe coughing COULD have caused some stitches to "cheese wire" cut through the muscle. Depending on the factors enumerated above, a muscle repair COULD fail with severe coughing. The only way to tell is by careful physical examination which may need to be supplemented by a CT scan.
For the time being, I would just have your surgeon examine you and wait forthe swelling to subside. Then, if neded, I would obtain a CT scan to asses the extent of muscle separation, if any, and see if it even requires repair.

Good Luck

Dr. Peter Aldea

Coughing after a tummy tuck more than likely did not do any harm, but the only way to be sure is to get examined by your surgeon.

Coughing, or other repetitive acts such as lifting or straining can cause the sutures in the muscle repair to break or cut through like a wire through cheese, and the repair can be undone. The bulge which was corrected can come back in all or part of the tummy. The sutures are not actually in the muscle, but in the fascia, or gristle, on top of the muscle. Only time will tell if the repair was undone. You will know after the swelling has all diminished, and 3 weeks is a bit early to tell. Recurrence or relapse of the bulge is unlikely but a possibility with muscle repair, and can be due to the reasons cited, as well as weak tissues.