What causes the stitches to split? Could it be it was not stitched up correctly in the first place?

This could be one reason, but highly unlikely considering that they kept the incisions closed for two weeks. Another reason could be that there is too much tension on the incision line, and another could be infection.

There are various reasons why a suture would 'spit'.  Absorbable sutures sometimes take long to absorb and eventually the body gets them out.  Non-absorbably sutures can sometimes get exposed if they are too close to the surface and the overlying skin thins out.

Thank you for your question.  I am sorry to hear about your situation.  From what you described, the wounds began to open two weeks after surgery on the right breast and 6 weeks after surgery on the left breast.  Since the wounds were held together for at least two weeks, I would say that the incisions were likely stitched appropriately.  There are several reasons for wounds to begin to separate.  It sounds like infection was the cause in your case based on your comments.  An infection can cause the overlying tissues to separate as the body is trying to get rid of the infection.  Despite all the preoperative antibiotics and postoperative antibiotics and sterile surgical technique, patients do get infections that can cause significant problems for the patient.  The cause of developing an infection is multifactorial.  I am sure it is very difficult to go through. Have an open conversation with your plastic surgeon and let him or her know about your feelings but please understand that your surgeon cares about your well being and if everything was in his or her control, they would have not allowed you to develop an infection.  Since everything is not in his or her control, please be understanding and give them the benefit of the doubt.  Together, you and your surgeon will get through this complication.I hope this helps.  Best wishes!William J. Vinyard, MDBoard Certified Plastic SurgeonPalm Beach, Florida

I'm sorry that you had this setback in your reconstruction. This must have particularly tough after you have progressed so far since mastectomy.  There are many reasons that surgically repaired wounds could have failed.  One is surgical technique in suturing (less likely), infection in the area, poor blood flow/ischemia, too much tension in the area, radiation induced changes which may show a combination if these problems (tight tissues, poor vascularity, etc).  Follow up with your plastic surgeon or seek second opinion to ensure that every measure is taken to avoid this in future surgeries.  Hang in there!  All the best,--Erik Hoy, M.D.

I am very sorry to hear about the complications you have experienced. These types of complications can be quite “devastating” especially as you are coming closer to the end of your reconstructive “journey”. I can assure you that these kinds of complications are also very distressing for the plastic surgeon involved. There are a variety of reasons why you may have experienced the complications. Online consultants, will not be able to provide you with specific/meaningful  explanations; your plastic surgeon will be your best resource in this regard. Best wishes; hopefully, at the appropriate time, you will be able to undergo breast augmentation.