Failed Muscle Repair After Tummy Tuck, What Would Be The Most Likely Reason For This? (photo)

Failure of fascia repair after abdominoplasty is almost unheard of. You should check with your surgeon as a revision might be indicated.

A variety of factors may be involved.  Personally, I use permanent sutures, although others use long lasting dissolving sutures.  The vomiting is another risk factor.  Abdominal exercises, especially when resumed too quickly, or weight gain are two more factors.  And, finally, patients have different quality fascia ( the abdominal wall canvas-like layer that envelops the muscles).  Poor quality fascia, which is essentially genetic, will not hold a repair well.  It is worth considering a repair with permanent sutures.  Good luck.

Based on what I read here, the likeliest cause is the vomiting. We all try to minimize nausea and vomiting, but not with 100% success. This can happen with permanent or dissolving sutures. 

There are still discussions about the relative benefits of permanent vs. non-permanent sutures. Non-permanent sutures have been demonstrated to be equally effective in abdominal wall closures since the 1970'ies. By the time the dissolving sutures are gone, the healing strength of the wound is stronger than the sutures were. 

All the best. 

Hello,

Thank you for the question and the photo.  There are a few things that can be occuring with regards to your abdominal wall.  The sutures could have broken, the sutures could have pulled through the tissue, the amount of tightening could have been insufficient, and if the suture used was a Vicryl or a Monocryl it could have weakened too soon.  Its difficult to know which of these is the cause.  The solution will be to go back in and re-tighten (re-suture) the abdominal wall.  This involve re-elevating all of the abdominal soft tissue similar to how it was done during the initial full tummy tuck.

All the best,

Dr. Remus Repta

It does seem that you have a recurrent abdominal bulge due to laxity of the anterior abdominal wall fascia.  An examination would be needed to determine the extent of the problem and whether or not a re-plication of this layers is indicated.  

Actually absorbable sutures are okay as long as they are the type that absorb over a long period of time which gives the muscle fascia time to bond ( PDS sutures).  If it was an early recurrence of the diastasis it is more likely it was from the vomiting. However, even with a secure repair using permanent suture , it was shown several years ago by Dr. Jansen at Tulane that all abdominoplasty repairs do relax to some degree. In fact, if you go back into the history of abdominal surgery many years there used to be a procedure called the "darn" that was used for eventration repair (diastasis) back in the 50's and they recurred frequently leading to the demise of the darn procedure. Your result is not that bad   I would recommend being sure you are at ideal body weight and if still present have your muscles repaired which can be done endoscopically without opening the entire incision. 

There is no way to know why this happened.  Perhaps it was the coughing after surgery.  Perhaps a suture dissolved quicker than expected.  From the sound of your question it seems to imply that perhaps the absorbable sutures were a problem.  Many surgeons use long lasting absorbable sutures for the muscle repair.  I myself use permanent sutures in the muscle repair in addition to absorbable but different surgeons have differing opinions on this.  Perhaps you did too much lifting too quickly.  Perhaps it was something else.  At this point there is really no way to tell and it sounds like you are already seeing other surgeons to get options for repair.  The problem is that no surgeon can guarantee you that with another repair it will not occur again since they don't know why it happened in the first place.  I'm sorry my answer could not answer more.  Best of luck!

HI babymicky.  I am sorry about your problem.  It is common to use long-acting absorbable sutures for the muscle repair, and this does not cause the repair to fail.   Failures in the first weeks after surgery are usually due to techical problems, like pulling on the repair from vomiting, broken sutures etc.  Later failures may be due to patients returning to exercise too early, or relaxing of the abdominal wall tissues that are holding the sutures. I suggest you see your plastic surgeon to disucss your concerns.

Thanks for the question.  I would imagine that your repair of the rectus muscles may have torn during the coughing, or the sutures have dissolved prematurely.  If the problem worsens as further time evolves, the muscle repair can be performed once again, but I would advie using permanent, non dissolving sutures.  I have done this with every abdominoplasty that I have done, and I don't believe I have ever had a dehiscence or separation of the muscle repair.

 

Plan on following up with your Plastic Surgeon to carefully observe your progress and to decide on a future plan of action.

 

Good luck to you.

 

Frank Rieger M.D.  Tampa Plastic Surgeon