"Spitting sutures" is never "normal," but it is occasionally seen by virtually every plastic surgeon. You have to understand that dissolving sutures are very close to the skin surface, and can become contaminated by skin surface bacteria, or bacteria that reside in pores, hair follicles, and sweat glands, some of which the needle and/or suture material can pass through. So the knots or suture material can become tiny dark, moist, warm havens for a few bacteria, and if you have enough of these, and not quite enough infection fighters (white blood cells, antibodies, and antibiotics within your blood stream or tissues), a stitch abscess forms. Lots of surgeons don't want to use the term stitch abscess, so they say, "stich reaction," "stitch allergy," or simply "spitting stitch." These are NOT an allergy to suture material, or "reaction," but simply a few localized areas of stitch infection or abscess. Think about it--if this was a true "reaction" or "allergy," it should occur at EVERY location where that type of suture is used. It doesn't. and is therefore NOT allergy, or "reaction." It is localized infection, and that's why it is treated by removal of the contaminated material and antibiotic ointment locally. Plus oral antibiotics if the skin show signs of cellulitis around one or more of these localized infections.See, all this talk of bacteria and infection, and you'll wonder about "flesh-eating bacteria (OMG)" or in days gone by, "The STAPH (OMG)." Fear not, these are usually the "normal flora" skin bacteria that live on our skin, in our ducts, and are pretty much everywhere, despite surgical scrubs, and prep solutions. That's why "stitch spitting" is pretty common.Things that surgeons can do are use monofilament sutures like Monocryl or PDS, and avoid braided sutures like Vicryl or Dexon (the microscopic interstices in the braided suture material are "safe havens" for bacteria), but if you must use these sutures, at least soak the braided suture in antibiotic solution.Things that patients can do are Hibiclens showers before surgery, and choosing a surgeon who understands that Vicryl and Dexon sutures for skin closure are really not the best. Yeah, it's a real deal, but habit and training are hard to overcome.So stitch spitting exists. You have to be sure these remain localized issues, and that bacteria do not reach your implants. Implant contamination can lead to capsular contracture; implant infection requires implant removal. Both of those are "big deals." As in big problems. I worry a bit about your "clear liquid" drainage. If this signifies communication with your implant pocket, this is worrisome. Keep in touch with your surgeon. Best wishes! Dr. Tholen
