Are there risks associated with permanent sutures used for tummy tucks?

Question

After a lot of reading, it seem that permanent (non-dissolvable) sutures are commonly used internally when repairing the abdominal muscles in tummy tucks, often a form of nylon based on what I'm reading. This makes me kind of anxious: do they tend to hold up for life? What happens if one breaks? Does the risk of them breaking go down as time passes - or is it less of an issue if they do break years later because scar tissue forms? And finally, do some have immune responses to permanent sutures?

Peter D. Geldner, MD · Answer

Thanks for your great question. It is true, many plastic surgeons use permanent sutures for muscle plication. I used to also. There were some annoying features my patients experienced which led me to use PDS sutures( long lasting, dissolving). Permanent sutures don't change over time, but their importance diminishes over time. Scar tissue takes over. During secondary procedures, I sometime find the old sutures with no tension; serving no purpose. If a suture breaks, the result depends on when it happens, and if there is one, two, or many sutures in the repair. So the answer to your question is complicated. I am not aware of any immune response to permanent sutures

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding the safety and durability of permanent sutures used in tummy tucks.
Due to their proven reliability and safety, permanent sutures are routinely used in various medical fields, including orthopedics, vascular surgery, and neurosurgery. In the context of a tummy tuck, these sutures serve to secure the rectus muscles, contributing to long-lasting results permanently.
While the sutures are designed to last a lifetime, there are rare instances where they might break. To mitigate this risk, surgeons often use multiple permanent sutures. This way, even if one breaks, the others remain intact, preserving the integrity of the abdominal wall repair.

As for longevity, the likelihood of sutures breaking does not increase with age. Furthermore, these sutures are biologically inert and typically do not trigger immune responses. Very rarely, an infection may occur or the body may reject a suture, necessitating surgical intervention for removal. However, these cases are extremely uncommon.
I hope this clarifies your concerns about the use of permanent sutures in tummy tucks.
Sincerely,
Dr. Katzen

Cagil Meric Erenoglu, MD · Answer

Hi, IgLmx! Thank you for your question.
While rectus diastasis repair, polypropylene is the most commonly used suture. It is permanent and stays with you throughout your life. While time, the strength of the suture itself reduces, but the strength of the fibrotic tissue increases. So breaking of the suture becomes no longer an issue in following months.
In the first 6 months, breaking of this suture may lead to failure of the procedure, necessitating a revision or acceptance. That's why we do three layers of repair to guarantee as much as possible.
It is very rare, if not none, to have a reaction towards this suture.

Camille Cash, MD · Answer

Scar tissue will slowly grow to surround the permanent sutures, so if used they are typically not a problem down the road.  The type of sutures used will vary be surgeon.  I encourage you to ask questions about your surgeon's preference and reasoning.  It is important that you are comfortable and confident in your surgical plan.

Connie Hiers, MD, FACS · Answer

Scar tissue forms around sutures over time. Initially, permanent sutures are used to tighten the muscles since that area heals slowly and scar tissue forms slowly. Dissolving sutures would be dissolved before the muscles had healed. Once healed, scar tissue is stronger than sutures.  Plus, these sutures are usually fairly deep and not felt through the skin.  These sutures do not create much immune response outside of expected scar tissue.

Mats Hagstrom, MD (license on probation) · Answer

Foreign bodies are placed inside of people on a On a daily basis and have been for many many years.
Non-reactive substances are sealed off by the body with a thin layer of scar tissue membrane called s capsule. Suture material will weaken overtime and after 5 to 10 years will not have the strength it did when it was first put in.
At that point scar tissue holds tissues in place and the suture material is no longer necessary.
Some providers use slow absorbing absorbable suture which also stays in the body for a long time but it will eventually go away. even slow absorbing sutures lose their strength much more rapidly than permanent sutures.
From a patient’s perspective there really is no difference between the two so surgeons rely on the most definitive long lasting suture material.
Regardless of what material is used you will have internal sutures that will be present for a minimum of a few years. there’s really no difference from a patient’s perspective.
In the end the most important variable is choosing the most skilled and experienced provider.
In the end there are only two variables that really matter when it comes to cosmetic surgery.
They are patient candidacy and skill of the surgeon.
It’s patients focus on just those two variables and put in a thorough effort in finding the best provider the chance of having a positive long-term outcome and overall good experience is likely.
Understanding your own candidacy for the procedure and with that recognizing what can and cannot be accomplished with these procedure including alternative procedures is an important part of high patient satisfaction.
Choose the right provider by having multiple in person consultations.
Start the process by first getting quality pictures of your torso taken the same way plastic surgeons take before and after pictures.
Pictures should show your torso from your knees to your shoulders. have someone else take the pictures or use the timer on your camera with the camera about 8 feet away. Stand in a neutral position with pictures shoving your front, side and backside.
When reviewing before and after pictures always select only patients who have similar body characteristics to your own.
Look at lots of before and after pictures online on the sources like this website or plastic surgeons own websites. Create a rating or a grading system for what you believe our quality results. again focus only on patients who look like your body in the before pictures.
There’s no point in looking at the results of patients who have a different body than you do in the before pictures.
In regards to the abdomen there are generally for variables that determine what it looks like. These are abdominal skin laxity typically related to previous pregnancies or weight loss, excess subcutaneous fat, muscle separation from previous pregnancies and lastly excess intra-abdominal or visceral fat.A quality assessment should differentiate all four of those variables.
A tummy tuck primarily treats abdominal skin laxity and muscle separation.
If those are the two main variables that are keeping your abdomen I’m looking the way you want the tummy tuck is most likely the correct procedure.
If excess subcutaneous fat is an issue then weight loss or liposuction may be appropriate.
Individuals who have excess visceral fat should lose weight in order to reduce the bulging of their abdomen and before considering a tummy tuck.
Judge tummy tuck results primarily based on the following criteria.
First and foremost is a natural appearing central abdomen and belly button. Creating a natural appearing belly button during a tummy tuck is one of the harder aspects of the procedure. Surgeons who can do this well consistently tend to be detail oriented and are willing to put in the work to get quality results.
It takes time to do quality work. Ask your surgeons exactly how many hours the surgery will take.
Surgeons who are detail oriented and are trying to get the best results without compromise will typically take 3 to 5 hours to do a full tummy tuck.
I’ve also seen plastic surgeons do the same procedure in 90 minutes or less. Those providers cut corners and results are compromised.
Operating room and anesthesia costs typically go by the hour and are expensive.
Reducing operating time can serve as a financial motivator for surgeons who are looking to maximize profits.
What you want is a surgeon who is a patient advocate and is willing to take the time required to get the best results.
The second variable after the central abdomen is the design of the incision.
Incisions should be placed as low as possible. Ideally the incision should be in the groin crease. My preferred approach is to have the incision be slightly convex over the mons pubis then follow the groin crease gradually up over the hips. 
The incision should look like it follows anatomic contours naturally and evenly on both sides. Do not judge surgeons based on what the scar itself looks like since that is more related to how individuals heal and how long after surgery photographs are taken.
Skin incisions take 12 to 18 months before they are fully mature and stop improving.
Most after pictures are usually taken at six months at which time skin incisions have not fully matured.
The torso should look attractive, balanced and appropriate from all angles including from behind.
Individuals who have skin laxity that continues on the side or onto the back should have an extended procedure. those who have a fat distribution that is unbecoming without good feminine curves in the love handles should have liposuction done during the tummy tuck or as a separate procedure in order to have an attractive torso from all angles.
If surgeons recommend doing liposuction of your backside in conjunction with the tummy tuck then you need to see before and after pictures of what that looks like.
It’s difficult to do quality liposuction of the waist and love handles with patients laying on their back. It’s difficult to move patients after a tummy tuck and if somebody is adding liposuction including charging for it as an additional procedure then you should ask specifically in what position your body will be while they do liposuction.
To get quality liposuction results of the love handles waist and back patients need to be turned either on their side or face down.
Likewise individuals who need an extended tummy tuck with skin removal more than just the front of the abdomen also need to be turned during surgery.
It should be made very clear during the consultation if you need an extended tummy tuck or not.
If an extended tummy tuck is recommended then you should make sure the surgeon is planning on turning you during surgery.
Insufficient skin excision on the sides and waist and individuals who have extensive skin laxity will result in a condition called “dog ears”. This results from an insufficient skin excision on individuals who have skin laxity that continues beyond just the front of the abdomen.
Ask each provider to open up their portfolio and show you their entire collection of before and after pictures during in person consultations.
Ask providers to only show you before and after pictures of patients who have similar body characteristics to yourself.
Bring your own pictures for reference to make sure they are only showing you examples of patients whose body looks similar to yours.
There’s no point in seeing impressive results on patients who were far better candidate for the procedure than you are.
Candidacy for surgery is a spectrum.
Typically the ideal candidate for a tummy tuck has only two variables keeping them from looking perfect. those two variables are the two variables treated by a full tummy tuck namely abdominal skin laxity and muscle separation. If there are other variables like excess subcutaneous fat, visceral fat or muscular skeletal structure that is less than ideal then candidacy will decrease.
For example, barrel chested individuals who have a sternum that sits significantly in front of the pubic bone often end up with bulging of their upper abdomen after a full tummy tuck.
Sufficiently experienced surgeon should be able to predict your results and tell you exactly what type of candidate you are for the procedure.
During the consultation they should show you multiple before and after pictures of previous patients who are very similar body characteristics to your own.
Ask providers to show you examples of excellent outcomes, average outcomes and outcomes that did not turn out as well as they had hoped.
Ask providers what the revision rate is and what their revision policy is.
Ask them what’s the most common requested reason for a revision is.
You should also ask what the complications are in regards to actual percentages and what having each of those complications will entail.
The most common complication after a full tummy tuck is a seroma.
You should ask each surgeon what there’s seroma rate is as well as how they treat them.
Fluid buildup or a seroma is reported to happen as often as 20% with this procedure.
This complication is minimized by leaving drains in place long enough that fluid buildup do not occur after the removal of drains.
Patients are typically not found of having drains in for long periods of time so it is always a balancing act.
For reference an experience surgeon should have no difficulty showing you at least 50 sets of before and after pictures of commonly performed procedures like a full tummy tuck.
Providers may be apprehensive of showing you anything other than their “best of their career” before and after pictures.
I think you’ll find that the most talented and experience surgeons will be the most open to showing you a variety of results and have no problem talking about variation in outcomes and being honest about complications.
Your goal in the end is to find out what average results look like in the hands of each provider and previous patients who have your candidacy.
Take notes during the consultation regarding both the quantity and quality of before and after pictures and especially how many matched your body type.
You should also take notes about the overall thoroughness of the consultation regarding all aspects that should be discussed during a proper plastic surgery consultation.
This includes at a minimum medical history, physical examination, assessment, review of recommended procedure and alternatives, review of before and after pictures, risks and benefits, preparation for surgery, recovery, complications and how they are treated, revision rates etc. etc. etc.
Providers who have consultations done by anyone other than the actual surgeon who’s going to do your procedure should be a major red flag.
Start by scheduling at least five in person consultations with local board-certified plastic surgeons in your community.
Avoid virtual consultations whenever possible.
I highly recommend against traveling long distances for elective surgical procedures especially for a tummy tuck.
Continue having consultations until you feel very comfortable do you find the most talented and experience provider for your needs.
This may require more than five consultations.
A full tummy tuck is a permanent and irreversible operation.
If done poorly improving the results is almost impossible.
This is especially true if the Central abdomen and belly button do not turn out well.
A full tummy tuck involves a long incision including a scar around your belly button.
You should consider your own skin healing history and take that into consideration and discuss that during consultations.
Most people have had some skin injury or surgical procedure at some point in their life.
Reviewing how each individual has healed in the past is very informative and making an assessment of how the scar will look long-term.
Individuals who are prone to poor skin healing may want to consider not having this procedure.
This includes people perform keloid or hypertrophic scars from minor injuries or previous surgeries or lacerations.
When in doubt slow down and schedule more consultations.
A full tummy tuck is probably the most invasive operation someone can have it for cosmetic purposes.
The recovery can be intense and overwhelming. patients should go in to this process being well-informed and well prepared.
This means being prepared physically, emotionally, financially and physiologically.
In the end the most important variable is finding the right provider.
In general there isn’t much people can do to change their candidacy. The biggest exception of this is individuals who are obese.
Obese individuals should seriously consider losing weight before considering having a tummy tuck.
Individuals with a history of cigarette smoking should also seriously consider not having this procedure.
Best,
Mats Hagstrom MD

Jeffrey C. Hamm, MD - Account Suspended · Answer

Hi and welcome to our forum!
Of significance, suture material becomes useless as a method to hold tissues together after a period of 2-3 months as the tissues bond together with the development of scar tissue. Permanent abdominal fascial sutures do not dissolve. They are usually utilized for their initial strength. However, there are occasional patients who develop a late infection of the fascial sutures, which may ultimately require suture removal, even months-years later. Permanent sutures are biologically inert. 
Absorbable fascial sutures dissolve over a period of months. They are not quite as strong as non-absorbables and are usually used in order to prevent these late infections....but as they are weaker, they are more prone to rupture with recurrence of the diastasis recti.
There are advocates in both camps...(and there are some surgeons who still use wire for their fascial closures).
Visit a board certified plastic surgeon for evaluation and discussion...and don't overthink it!
Best wishes...

Richard P. Rand, MD, FACS (retired) · Answer

I personally prefer very strong dissolvable sutures. After 8 weeks the muscle repair has healed and I let my patients begin light ab exercises. 30 years ago, I used permanent sutures when I used the tissue from tummy tucks to make new breasts (TRAM flap) and occasionally they cause permanent discomfort. So I switched to dissolvable for TTs and have had no problems.

Are there risks associated with permanent sutures used for tummy tucks?

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