Any recommendation for permanent vs absorbable sutures for rectus plication (I am an athlete)?

Question

I am planning to do a Tummy Tuck and just curious the physicians thoughts on absorbable vs permanent sutures for rectus plication. I am an athlete and I lift heavy weight and I am wondering if there is any opinion on this here in RealSelf. Thank you.

Kenneth Hughes, MD · Answer

The sutures in muscle repair are permanent sutures. You will not see or feel them. The deep fascia of the skin, the lower layer of the skin (DERMIS) and the skin are all closed with absorbable sutures.

Gary M. Horndeski, MD · Answer

The technique I use for rectus plication is permanent sutures made from Prolene. Also, if you are not planning future pregnancies, I use mesh to reinforce the repair. The mesh creates a more hourglass figure by compressing the abdominal wall resulting in early satiety and helps maintain a reduced weight. Mesh is incorporated into the body and quite strong.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ben Lee, MD · Answer

Thank you for your excellent question. The idea behind sewing the rectus muscle bellies together during abdominoplasty is to allow them to heal to each other, thereby correcting the diastasis. This is a process that takes several weeks. Once they are adhered to each other, the sutures are no longer necessary. I have used both during my career. Early on, I used permanent polyester sutures and had no problem with them. Occasionally, in a rare, very thin individual, you could feel them under the skin. I switched to absorbable sutures when barbed, PDS sutures become available. These sutures last a very long time, on the order of months. They provide a very secure muscle repair, and because of their barbed nature, a surgeon can save a bit of time in the OR. Through hydrolysis of the suture material, they completely dissolve. I wouldn't say one is better than the other, but it's nice to know that no foreign body remains once the absorbable sutures are gone.

Gerald Minniti, MD, FACS · Answer

Although sutures matter for only about 3-4 months (after that scar tissue does the work), there are no currently available absorbable sutures that have sufficient tensile strength that lasts that long. Therefore, I use a permanent suture, and have not had a recurrent diastasis in 21 years of practice.

Ronald J. Edelson, MD · Answer

I prefer non absorbable sutures. They are stronger and hold up over the long term, absorbable sutures are used by many surgeons as well and seem to work okay as well.

George Marosan, MD · Answer

Thank you for your question. In my practice, I use absorbable sutures for the muscle tightening in my tummy tucks for over 25 years. Never seen one result being undone. The dissolvable sutures go away slowly over 4-8 months. Their purpose is to bring the tissue together so they heal and scar together. Permanent sutures will not do better, but can have higher complication rates with infection and chronic oozing wounds. I let my patients resume exercise including abdominal crunches at 8 weeks postop. Hope this helps in your decision making.

Daniel Barrett, MD · Answer

Dear bweaver10,
every plastic surgeon has his own intraoperative protocol which he recommends to his patients. Both types of sutures are a viable option. I would suggest you to discuss this with your plastic surgeon.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Nelson Castillo, MD · Answer

Thank you for sharing your question.  Once the muscle repair is healed the style of sutures matters little and is usually determined on the comfort level and experience of your surgeon.  Hope this helps

Devan Griner, MD · Answer

This is a fantastic question and one my partner and I were discussing just the other day. The short answer is - we don't know. To my knowledge, there has not been a long-term outcome study done on the use of permanent vs absorbable sutures in a tummy tuck. You will just hear a lot of "in my experience" answers, so its good to get a lot of opinions. Having trained as a full general surgeon prior to my plastic surgery training, I find a strong correlation to abdominal hernia surgery and abdominoplasty (tummy tuck). There are hundreds of studies that show that dissolvable mesh and sutures will pretty much guarantee a hernia recurrence and another surgical procedure. The principles of hernia surgery parallel those of a tummy tuck in that you are trying to tighten or patch the abdominal wall and try to spread out that tension so that it doesn't come loose and cause a recurrence. So, here is the "in my experience" part. In my experience, in every person that has come to me wanting to have their tummy tuck re-done, they all seem to have one thing in common. Dissolvable sutures. I would love to say that none of my patients has ever needed a revision, but patients rarely go to their original surgeon for a revision surgery. So I hope none of mine have, but who knows. The advantages to absorbable suture are: way faster for the surgeon, less chance of a palpable knot or a stitch abscess, and eases the minds of those worried about foreign materials in their body. The advantages to permanent sutures are: longer lasting results (in my opinion). Given your athleticism and straining, I would lean toward permanent sutures. Great question!

Camille Cash, MD · Answer

Either suture type will provide strong abdominal wall correction once you are fully healed.  I encourage you to discuss your concerns with your surgeon.  It is important that you feel comfortable and confident in your surgical plan.