I've been researching different types of sutures & I'm hesitant, can you address these concerns?

Thank you for your question. It’s completely understandable to feel hesitant before undergoing such a significant surgery like a tummy tuck with diastasis recti repair. Let me address each of your concerns so you can approach this with clarity and confidence.

First, it’s important to understand that suture selection and technique are critical to successful outcomes. For repairing diastasis recti, permanent sutures are typically used to bring the separated rectus abdominis muscles back together. These sutures are designed to withstand the tension of muscle repair and ensure long-term results. Some patients report feeling tightness or discomfort where the sutures are placed, especially in the first few weeks post-op, but this sensation usually subsides as the tissues heal. However, the skill of your surgeon plays a significant role in ensuring the repair is done properly and minimizes complications.

Regarding the issue of quilting sutures, these are often used to secure the abdominal skin to the underlying tissues. They help minimize fluid collection and reduce the need for post-operative drains. While some patients experience discomfort or feel "tightness" at these suture sites, this discomfort typically resolves as healing progresses.

As for the risk of sutures opening or complications like burns during liposuction, these issues are often related to the technique and experience of the surgeon. It’s crucial to choose a board-certified plastic surgeon with extensive experience in abdominoplasty and related procedures. Proper pre-operative planning, precise technique, and adherence to post-operative care instructions can significantly reduce these risks.

Given that you’ve been living with diastasis recti for 20 years, repairing the muscle separation can provide tremendous functional and aesthetic benefits. It can alleviate back pain, improve posture, and give your abdomen a flatter appearance. To ensure you feel confident moving forward, I recommend consulting with multiple board-certified plastic surgeons. During these consultations, don’t hesitate to ask about the type of sutures they use, how they manage complications, and their specific techniques to prevent issues like burns or suture failure.

It’s clear you’ve done your research, and that’s an excellent first step. Finding the right surgeon and discussing your concerns openly will help ensure you achieve the best possible outcome.

Sincerely,
Dr. J. Timothy Katzen, MD, FASMBS, FICS

Unfortunately, you have not provided photographs of told us your height and weight. However, if you have a diastsis recti, often times this will need to repaired with sutures. The sutures that are used are usually Prolene which are non-absorbable sutures. There are other sutures that are available. However, if you have a very bad diastasis recti and you are not planning future pregnancies, then mesh can be used. The mesh is made from polypropylene and is a large piece that is sewn from side to side. This provides increased mechanical strength, helps maintain a reduced weight and creates a more hourglass figure. Additional information is needed to give a more accurate answer.

Best Wishes,

Gary Horndeski M.D.

The type of suture used to repair the diastasis is a separate concept from quilting sutures (which are used to suture the skin to the muscle to avoid drains in a tummy tuck). The two types of sutures for diastasis are absorbable vs permanent. I actually use both. I use a permanent suture for the strength of the repair and then cover it over with a second layer of barbed, absorbable suture to limit the risk of infection of the permanent suture in case there are wound healing issues that can increase the chance of bacteria infecting the permanent suture.

Thank you for your question. The type of suture used, dissolvable or permanent does not matter. Some braided permanent sutures could have a higher rate of infection if there's a wound breakdown. I personally prefer dissolvable sutures (they dissolve in 6-12 months), by which time your tissues are strong enough and the sutures do not provide further support anyways. The complications you described has nothing to do with the type of suture used. Although these are rare, it can happen. Many times it is a technique issue (forcing tissues together under a great deal of tension), infection (I don't allow my freshly operated patients to be together with their cats, dogs or parrots), seromas, diabetic patient under poor control, obese patients and other reasons. See a board certified plastic surgeon for an in person consultation/evaluation and discuss your concerns. Good luck.

The problems you have heard of can occur with any type of suturing. The complications you mention were not caused by the type of sutures used

Dear Virginian,
Tummy tuck surgery is a complex procedure that requires a lot of suturing. In my practice the diastasis recti repair is done with # 1 prolene sutures in a combination of interrupted and continuous locking fashion vertically and additional tightening of deep fascia horizontally at the upper and lower abdomen. At times, when the abdominal wall is very loose, vertical tightening is performed laterally, bilaterally. My tummy tuck surgery is drainless unless the patient had liposuction before which requires a drain to help the body eliminate the surgical fluid due to the scarring from the liposuction procedure which makes the fluid absorption less effective. The abdominal skin is attached to the muscles fascia in a quilting fashion using 2-0 Vicryl sutures. The skin flap superficial fascia (Scarpa's fascia) is attached to the pubic bone with # 1 prolene in figure of 8 fashion. After excising the excess skin flap , the Scarpa's fascia in attached to the deep fascia with multiple interrupted 2-0 Vicryl and the skin proper is repaired with continuous subcuticular (Dermis) 4-0 Vicryl. The old belly button is attached to the skin at the new hole with interrupted 2-0 Vicryl for the Dermis and continuous 5-0 plain gut suture for the skin. With this technique it is very unlikely that the wound will open up.
As a rule, I do not perform tummy tuck surgery with liposuction due to the significant increase in major complications (including death) when they are combined as oppose to getting tummy tuck alone.
Always consult with experienced board certified plastic surgeon who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures in the photo gallery to make sure that they are numerous, consistent and attractive with flat stomach, nice belly button. low abdominal scar and improve posture.
I hope this helps.
Best of luck,
Dr Widder
widderplasticsurgery.com

Each surgeon has a different approach to suture use for procedures. Ultimately, each surgeon may have a different approach to it. My approach is generally to use permanent stitches to treat the diastasis as there is a fear that if you use dissolvable stitches, the repair may undo itself over time. The stitches that I use along the incision closure are dissolvable stitches that rarely create any lasting concerns for patients as they dissolve.

Your muscles can be brought back together in two ways. The surgical way is with using permanent sutures to bring things back together. EMSculpt is the nonsurgical way which work nicely in many women. Liposuction only removes excess fat. The burning was not from liposuction but from something like laser or Renuvion to help tighten skin with heat. In areas where sutures open is usually related to infection.

The type of sutures used in your friend's surgery were not the cause of the issues experienced. I encourage you to visit with a few board certified plastic surgeons to learn more about this procedure and to put your mind at ease. Review the surgeons' websites including credentials and before and after photos. During your consultation ask questions including risks and benefits to the procedure. It is important to be comfortable and confident in your surgeon and surgical plan.

hello, thank you for your questions

1. Burning in lipo procedure: this complications arise from an excessive liposuction, use of an extremely tight compression garment or a combination of both. It is not a common complication with experienced surgeons, and most of the time you can see just a pin point burn from either the tip of the cannula beating the skin too superficially, or a lengthy narrow burn from a too tight compression garment. How I avoid this personally: more than 12 years experience doing liposuction, managing personally the tightness of the compression garment (there will be plenty of time for tight garments, but in the beginning you need to let your skin heal first).
2. Opening of the incision above the vagina, this again is not common but be aware that in a tummy tuck incision, the mid point is the point with the most amount of tension. Any excessive tension on this point will create thicker scars, small openings of the wound because of the added effect of tension and inflammation, and excessive pull on the vaginal crease, up to the point of deforming it if the tension is too much. How to avoid it, go with a certified surgeon that has experience on tummy tucks, this is not a common mishap.
3. pain in quilting sutures: personally I don't use this sutures, stopped using them about 7 years ago, as I saw minimal to no difference on not using it. A drain will be enough to control the seroma. The pain felt comes from trapping some muscle fibers on the suture bite.
Hope to have been able to address your concerns. I attached a TT-Lipo combination from my instagram