Dissolvable versus permanent sutures for TT muscle repair?

Hi randomstuff088,
Rectus plication, also known as 6 pack muscle tightening, is an important part of most tummy tucks. Anatomically, the rectus muscles are supposed to sit next to each other, right and left, in the vertical midline. With weight gain and/or pregnancy, this junction is often stretched out. This right to left gap or weakness allows your intra-abdominal contents to bulge forward, producing an upper and/or lower abdominal bulge. Rectus plication tightens this right to left gap, restoring your original anatomy.
Your body has an amazing capacity to heal. For surgeons using dissolvable sutures, the expectation is that your body will produce enough scar tissue at 3 months when the sutures dissolve that the sutures are no longer needed. For surgeons using permanent sutures, the thought is that no matter how much scar tissue body produces, the sutures will always keep the rectus muscles in the position placed in the operating room, as the stitches themselves will stay on a permanent basis. In a hybrid model, many surgeons will put a layer of permanent sutures, followed by a layer of absorbable sutures. This puts well vascularized fascia over the top of the permanent stitches, to minimize any risk of infection or problems if you develop an open wound.
Hope this helps.
Best,Christopher Pannucci MDBoard Certified Plastic SurgeonPlastic Surgery NorthwestSpokane, Washington

Thank you for your question regarding the choice of sutures for muscle repair during an abdominoplasty (tummy tuck). The type of suture used—dissolvable or permanent—depends on the surgeon’s preference, experience, and the specific needs of the patient. Both types have their own advantages and considerations.

Dissolvable sutures are designed to break down and be absorbed by the body over time. These sutures are often preferred for patients who may want to avoid having permanent foreign materials in their bodies. They reduce the risk of long-term complications, such as granulomas or irritation caused by the sutures. However, since they dissolve, they may not provide as long-lasting support for the repaired rectus abdominis (stomach) muscles. This could potentially lead to a recurrence of muscle separation (diastasis recti) over time, especially if significant strain is placed on the abdomen, such as during weight gain, heavy lifting, or pregnancy.

Permanent sutures, on the other hand, provide lifelong support for the muscle repair. They are particularly effective in maintaining the integrity of the muscle repair, even under long-term strain. The downside is the potential for irritation or discomfort in rare cases, as the sutures remain in place indefinitely. In some patients, these sutures can become palpable or cause localized issues, though this is uncommon.

Given that your husband has had a vasectomy and you are not planning to have more children, permanent sutures will provide you with the most durable repair, especially if you are seeking long-term abdominal stability. That said, if you have concerns about foreign materials, discuss dissolvable sutures further with your surgeon.

Ultimately, the skill of the surgeon and the technique used are critical factors in achieving excellent results. Both types of sutures can be effective when applied correctly. I recommend consulting with board-certified plastic surgeons who are experienced with both methods. Share your specific concerns, and ask for examples of their outcomes with each type of suture to help you make an informed decision.

Wishing you the best on your journey to a flatter, more functional abdomen!

Sincerely,
J. Timothy Katzen, MD, FACS

I always use permanent sutures for rectus plication. I've seen several patient done by other physicians who used dissolvable sutures and had a recurrence of their rectus diastasis.