Could two suture granuloma after mommy makeover & then implant removal be an autoimmune reaction?

Question

Hi, I had mommy makeover including lipo on both flanks, breast augmentation and tummy tuck by board certified doctor. I had medical clearance from my primary care doctor. Before surgery, I have insulin resistance, celiac disease and hypothyroid. My plastic surgeon was aware of these before proceeding to surgery. After surgery, I was experiencing symptoms. I had implants removed. Now I have two areas of suture granuloma on epigastric mid region. Is this autoimmune reaction?

Shaher W. Khan, MD · Answer

Hello, thank you for your question. Please see the attached video to explain your question specifically in detail. It sounds like you have been through a lot with your surgery and health condition. Suture granulomas can occur as a reaction to sutures or the body's response to foreign materials. It is important to consult your surgery about your concerns. Your health and peace of mind are the top priorities.

Daniel Barrett, MD · Answer

Dear Swflmom81,

I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Tek Przylecki, MD, FACS · Answer

Suture granulomas are not uncommon and can occur. This usually happens when a buried (dissolving) suture is placed superficially close to the skin edge. The mechanism of these sutures actually depends on your immune system reacting to the sutures and the inflammatory response that occurs. Granulomas can occur and I do not believe there is any data implicating autoimmune disorders in this process.

James Knoetgen, III, MD · Answer

Suture granulomas are small, localized inflammatory reactions that occur around surgical sutures, often as the body attempts to break down or "reject" the suture material. These are generally not considered autoimmune reactions but rather localized foreign body responses. However, certain factors could make this process seem connected to immune or autoimmune issues:
1.	Suture Material Sensitivity: Some individuals may have a heightened immune response to certain types of suture materials (e.g., non-absorbable or absorbable sutures), which could mimic or exacerbate an inflammatory or immune response.
2.	Autoimmune Conditions: If you have a preexisting autoimmune condition, your immune system might overreact to the presence of foreign materials like sutures or implants, potentially leading to more pronounced or persistent granulomas.
3.	Implant Removal and Immune Response: After implant removal, the body's immune system might react to residual material, scar tissue, or suture fragments, potentially causing granulomas. While this isn't an autoimmune reaction in the strict sense, it could involve heightened immune system activity.
4.	Chronic Inflammation: Chronic inflammation from granulomas or other post-surgical complications could, in rare cases, trigger or unmask underlying autoimmune tendencies if they were already present.
If you suspect an autoimmune connection, it might be worth discussing this with your surgeon or a specialist in autoimmune diseases. A thorough evaluation, including blood tests to check for markers of autoimmune activity (like ANA, ESR, or CRP), could help rule out or confirm any systemic immune involvement. Additionally, if the granulomas persist or worsen, a biopsy may be necessary to better understand the nature of the reaction.

Camille Cash, MD · Answer

I'm sorry to hear of the issues you've been having since your Mommy Makeover.  Suture granulomas are not uncommon and can occur regardless of an autoimmune history.  I encourage you to visit with your surgeon who can address the suture granulomas.  Once treated they tend to heal well.

Connie Hiers, MD, FACS · Answer

Suture granuloma can occur in any area that has sutures. Usually, the granuloma is related more to a low-grade infection which will not clear until the suture is removed.

Mats Hagstrom, MD (license on probation) · Answer

Suture granulomas are typically caused by bacterial contamination of sutures close to the skin surface. The foreign body (suture material) should be removed to get these to heal. Suture granulomas are not uncommon when surgeons use absorbable suture. It is not an auto-immune disease. 
Best,
Mats Hagström MD

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