How many layers of sutures are recommended for an abdominoplasty?

Question

How many layers of sutures are recommended for an abdominoplasty? I’ve had a few consultations and different surgeons had different recommendations. One has said they only do 1 layer of stitching, this doesn’t seem very substantial? What is considered best practice? I’m referring to the muscle repair not the external incision.

J. Timothy Katzen, MD, FACS · Answer

Hello Glorious756390,

When it comes to an abdominoplasty or tummy tuck, the number of suture layers used during the muscle repair can vary depending on the surgeon's technique and the patient's specific needs.

I do a two-layer closure using permanent sutures for muscle repair during abdominoplasty. This technique has proven reliable and effective in providing a tight and sturdy muscle repair that can endure the test of time. I've had follow-up conversations with patients even 20 years after their tummy tucks and body lifts, and I'm glad to share that their muscle plication remains tight.

However, it's important to remember that the 'best' practice can be subjective and may depend on various factors. These can include the patient's anatomy, the extent of the muscle repair needed, and the surgeon's experience and preference. What matters most is your comfort and trust in your surgeon's ability to deliver the results you desire.

Thank you for your question. Best of luck in your abdominoplasty journey!

Sincerely,
Dr. Katzen

Finny George, MD · Answer

Hi, thank you for sharing your question. There is not formal evidence to suggest the specific number of layers the muscle repair should be done with to provide the best long term results. Most surgeons that I know will do two layers but trust your surgeon to provide a long lasting result if they have a track record of success.

Amir Sadr, MD, MSc (Plast), FEBOPRAS · Answer

Dear Glorious756390
Many thanks for your question. There is no hard and fast rule about this. As a principle the suture only works to approximate the edges of the rectus muscle and then the scar tissue forms and makes the repair stronger. So most of the times one layer of sticking would be sufficient. Sometimes in my practice I notice that the one suture does not provide enough tightening of abdominal muscles and then I may choose to run a second line of suture to tighten the abdomen more. This is a decision made by your plastic surgeon during surgery and is based on the condition of your muscles.I hope you find this explanation helpful.

Tommaso Addona, MD · Answer

Thank you for your question.
I historically repair the rectus diastasis with a three layer repair. The skin is closed in two to three layers separately.

Daniel Barrett, MD · Answer

Dear Glorious756390,
scar prevention begins in the OR during the surgery when I meticulously close wounds in multiple layers in order to reduce tension and reduce scars width. I tape my incisions during the early postoperative period to reduce micromotions of the tissues so the incision can heal earlier. I also use compression garments and later Biocorneum gel.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Lisa Sacks, MBBCh, FRCS · Answer

Dear Glorious756390,I'm not sure if you've had your operation already, but I saw your question and thought I'd answer it.I'm not sure which part of the operation you are referring to when you ask about how many layers.When I repair the muscles, I always use a TWO LAYER CLOSURE for the vertical muscle repair. I always use a permanent barb stitch without any knotting (called V-Loc) which gently holds the tissue, and doesn't squeeze or pinch it. For the subcutaneous (fatty tissue) I use one layer of continuous V-Loc quilting sutures, so that I don't get fluid collecting and I don't need to use drains, as I close down the dead space. These last for 180 days.For the skin closure I use a TWO LAYER V-Loc CLOSURE , one in the deep fat, with a thick stitch, and one in the dermis with a thinner stitch. There are no knots. No pinching of the fat tissue. No micro abscesses nor leaking fat.I hope this answers your question.

Jeremy S. Hurren, BSc, MBBS, FRCS (Plast) · Answer

I usually do a single continuous absorbable suture running from top to bottom on the muscle layer (strictly the rectus sheath which covers the muscle, I do not stitch the muscle itself) ie all the way down the middle. I sometimes do two layers but this is unusual. If there was a true hernia I would repair that separately before doing the main repair with the single continuous suture.I would consider a single layer to be standard practice.(I close the main 'skin' incision in 3 layers.).Best wishes.

Connie Hiers, MD, FACS · Answer

Each repair is different and requires different things. I have done from one to three layers depending upon how much visceral fat was present and how loose the muscle layer was.  Most surgeons make that decision while you are open and on the table.

Jon S. Wilensky, MD · Answer

For the internal “muscle repair” a single continuous suture is used. This is almost always a non-absorbable (permanent), braided suture which is extremely strong and can bring the muscle edges together for the repair. The stitching is done in an over-and-over fashion. While it is one continuous stitch, the tension is progressively advanced to complete the internal repair, creating the effect of a muscle “corset.”For the external incision, one layer of stitching is NOT substantial enough for an abdominoplasty closure. A minimum of 2 layers are required. In our practice we use 3 layers of closure stitching. All of the sutures are dissolvable so that you do not have to have any sutures removed. First, there is a deep anchoring layer that brings the abdominoplasty together. This is placed in the strength layer known as the fascia. Then the skin is closed in 2 additional layers to yield a fine-line scar that will be well-hidden in the bikini line.

Reza Alamouti, MD, FRCS · Answer

HelloThank you for the question.Surgeons have different approach regarding repair of the muscles. I do one layer with a strong barbed suture if it’s not wider than 2 finger breadth.

How many layers of sutures are recommended for an abdominoplasty?

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