Dissolvable versus permanent sutures for TT muscle repair?

Question

I'm looking into a muscle repair, abdominalplasty. Most of the surgeons that I've been researching all use permanent sutures, but I just recently had a consult with somebody that uses dissolvable. I would appreciate any guidance on the pros and cons of both. Husband had a vasectomy, we are not planning to have any more children. Thank you.

Christopher Pannucci, MD, MS · Answer

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

J. Timothy Katzen, MD, FACS · Answer

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

John L. Burns Jr., MD · Answer

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.

Ramsen Azizi, MD · Answer

In my experience of training with 40-50 surgeons, I found that almost all use a combination of permanent and dissolving depending on their preferences. I personally use a good strong permanent one as the main layer with a handful of long term dissolving ones on top as a "second parachute" if you cough or throw up after surgery so the main one does not break. The problem I personally see with using all dissolving is that after 3 months, they start to lose their tension and if you start working out and flexing too much, you can get more stretching than using a permanent, in my opinion. Make sure to look at a lot of the surgeon's postop photos to see looks that you like. If he/she can deliver that look you like with their technique, then that's more important than which technique they are using. Best of luck on your journey!

Daniel Barrett, MD · Answer

Dear randomstuff088,
surgical technique depends from surgeon to surgeon. You should ask to see the results and do your research online. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Gary M. Horndeski, MD · Answer

At the time of tummy tuck, the muscle is not repaired but the lining called fascia is repaired. Most surgeons use non-absorbable sutures such as Prolene. I would not recommend self dissolving sutures.

Best Wishes,

Gary Horndeski M.D.

Best Wishes,

Gary Horndeski M.D.

Chad K. Wheeler, MD · Answer

As long as you do not stress the repair for at least 6 weeks and the stitch used lasts at least 6 weeks it should not matter.  The duration and strength of the repair usually depends on the strength of your own fascia not the stitch.

Harry T. Haramis, MD, FACS · Answer

In my experience, with complete General Surgery training as well as Plastic Surgery, I prefer permanent sutures for the muscle/fascia tightening.

I perform this in layers with multiple sutures for lasting strength, results and to prevent breakage or dissolving during healing.

The other sutures for skin closure are absorbable in layers.

It is a plastic surgeon’s preference and should be discussed until you feel comfortable.

George Marosan, MD · Answer

Thank you for your question. For over 25 years, I have been using dissolvable sutures for my abdominoplasty muscle repairs. Not one infection or recurring separation of the muscle in any of my patients. A traditional abdominoplasty is a two dimensional operation. As a Total Definer surgeon, I approach the torso in three dimensions to create athletic youthful bodies. These are advanced techniques to bring out the muscle and bony anatomy. This techniques uses VASER Hi Def Lipo 360 degrees, +/- fat transfer and abdominoplasty as part of a total body reshaping.
See a board certified plastic surgeon experienced in advanced body sculpting techniques for an in person consultation/evaluation. Good luck.

Ashley Thorburn, MD · Answer

The choice between dissolvable and permanent sutures for tummy tuck muscle repair depends on various factors, including the surgeon’s preference, the patient’s healing characteristics, and specific surgical considerations. Dissolvable sutures eliminate the need for removal but may not provide as much long-term support as permanent sutures. Permanent sutures may offer stronger and more enduring muscle support but require removal. Consult with your surgeon to determine the best option based on your individual case.