Did torn tummy tuck stitches cause a bulge?

Question

Hi. I had a tummy tuck performed in Sept2011.Since Nov2011 I noticed a bulge under the belly button area. It took until Oct2011 to get an explanation. Dr says my muscles stitches have unexplainably torn. I've shown him the strange pointing out belly it does when I lye down and push. Anyhow he said he made the single stitch technic. My question:now that he will repair it, should I ask for multiples stitches? We found no obvious reason for the stitch to tear. I don't want it to break again!Thx.

Kenneth Hughes, MD · Answer

One running suture if broken would not produce a tiny area of recurrence. This is more likely one stitch among many that was compromised. Realize that this compromise was probably not the result of technical error. I see about 2 patients in 100 who have such weak fascia that stitches tear through the fascia as they are placed. Very poor fascia may not be able to sustain the repair.

Jonathan Saunders, MD · Answer

having an abdominal wall problem is not an unusual occurence.  there are many acceptable ways to correct this..  relax and take it easy postop so it has a good chance to heal the way you want it to

Aldo Guerra, MD · Answer

I'm glad you already discussed this with your plastic surgeon. You should continue to maintain a close relationship with your surgeon, as they are familiar with your anatomy already. As far as the suture breaking, that is uncommon. A more common scenario is that some of the tissue has re-stretched. Either way, it can be addressed by your plastic surgeon. Be sure that you have not gained any weight since surgery and be realistic about your results. A commonly used technique for muscle repair involves a 2-layered technique. If you decide to have revision surgery, you should discuss all the options for closure, contemplate the risks, and decide in consultation with your PS.

Jourdan Gottlieb, MD · Answer

Expressing your concern and suggestion is completely reasonable. A second layer probably will make a recurrence less likely.

	Thanks for your question, best wishes.

Norman Bakshandeh Day, MD, FACS · Answer

The diastsis repair can be done with a single or double layer of sutures. They can also be done with running or interrupted sutures. They can all break with straining and force

Peter J. Simon, MD · Answer

Did you ever hear a "pop" postop? Any activity that increases intraabdominal pressure--from straining to coughing--can cause breaking of the muscle plication sutures. I like to use multiple nonabsorbable ones. This way, if one breaks, the result is not compromised. Hope this helps.

Alberto Di Giuseppe, MBBS · Answer

Before performing a secondary surgery, you may need an ultrasound to assess the reason for the tear - if an hernia or diastasis of the rectus muscle has taken place. Sometimes the bulge is due to fat accumulation connected with lymphatic stasis in the area and permanent swelling. Permanent stitches or running continuous stitches is a preference of the surgeon. I do not think it makes any difference in the final outcome.

	I emphasise that it is crucial to assess the reason of the tear prior to moving forward with any next steps.

Tom J. Pousti, MD · Answer

I'm sorry to hear about the complication you have experienced after tummy tuck surgery. Hopefully you are working with a board-certified plastic surgeon. Depending on whether he used a single layer of “running” or “interrupted” sutures he will be able to re approximate the abdominal wall muscles that have apparently separated.

	 In my practice, the  “repair” of abdominal wall diastasis  is done in 2 layers.It won't hurt to express  your concerns in a constructive fashion.

	 Best wishes.

Did torn tummy tuck stitches cause a bulge?

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