1 or 2 Layers of Stitching Muscles in a Tummy Tuck?

Do most doctors complete 1 layer of stiching stomach muscles in a tummy tuck or 2 layers of stitching? Is one method typically better than the other? If so, why? I expect my tummy tuck to be "normal" in that I don't have excess weight, no stretch marks to get rid of, some diastasis due to 2 pregnancies (c-sections), no hernias, etc.

Doctor Answers 13

Double Layer Closure Of Abdominal Muscles In A Tummy Tuck

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Thank you for this great question and thank you for asking the right questions.  Plastic surgery is 75% technical and 25% artistry.  Therefore, understanding the surgeon's technique increases your chance of picking the right surgeon who is doing the technique that is best for you.  I believe most Board Certified Plastic Surgeons today use a two layered closure of the diastasis of the rectus (abdominal) muscles.  I am also sure most of us use non-dissolvable sutures.  I certainly do.  

I close the first layer with the figure of eight suture.  Because of the pulls in so many different directions on the abdomen, a simple suture is unlike to hold under the multiple forces on the human abdomen.  I suture figure of eight sutures from the umbilicus (belly button) to the pubic area, and then above the umbilicus to the bottom of the sternum.  The second row above this row is a running locking suture to reinforce the first figure of eight layer, and because the second layer pulls in a little more tissue from the periphery, it not only protects the first layer but improves the tightness of the abdominal muscles. 

Some may say this is too much information, but I believe the more informed you are, the better your chance of picking just the right plastic surgeon.

Mesh is superior to 2 layers of sutures

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At the time of the tummy tuck, the muscles are not sutured.  It is the envelope around the muscle called fascia, which is sutured.  Diastasis means that the fascia between the two rectus muscles has stretched and thinned.  Normally I use 1 layer of sutures to pull the fascia together, then I reinforce this with mesh.  The advantage of the mesh is it produces stronger repair, will help the patient lose weight and maintain a reduced weight.  There are several articles about the recently in the Plastic and Reconstructive Surgery Journal.

Best Wishes,

Gary Horndeski, M.D.

1 vs 2 Layers for Muscle Repair during Tummy Tuck

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I think it is fairly common for plastic surgeons to perform a 2 layer repair.  The added reinforcement prevent sutures from popping which can create unsightly bulges in the muscle repair.   

I do not offer the mesh repair unless a significant hernia is present.

Paul S. Gill, MD
Houston Plastic Surgeon

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Muscle repair

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There are many different ways to tighten the abdominal muscles at the time of a tummy tuck.  There is no evidence that two layers is better than one.  I would go with a plastic surgeon you feel comfortable with and take their recommendation.  Good luck!

Muscle Suturing In A Tummy Tuck

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The number of layers used to suture the rectus (stomach) muscles in a tummy tuck depend on the degree of muscle separation and the quality of the tissues surrounding the muscle, known as the fascia.  In general, “normal” patients like yourself with multiple pregnancies require two layers of muscle suturing to achieve a secure repair and to maximize the aesthetic potential.  There are certain instances, especially when there is a narrow muscle separation (rectus diastasis), when only a single layer of suturing is all that is needed.  This decision is usually made at the time of the operation when the abdominal wall is exposed.  Good luck with your upcoming surgery.

Mark Schwartz, MD
New York Plastic Surgeon

Muscle repair during a tummy tuck

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The abdominal muscles are generally repaired with a few layers of stitches, which can be permanent or absorbable. Two layers are strong enough to give a nice flat contour as well as have the strength to resist any rupture from coughing or straining in the early post operative period. Each surgeon has his or her own reasons for the type of muscle repair that they do, so you will need to ask your plastic surgeon specifically.

Best wishes,


Two rows of sutures are better than one

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Thank you for your question. Early in my career, I had a patient who performed a strenuous activity soon after her tummy tuck and pulled out or broke some of the sutures in the muscle repair. Unfortunately, to repair this I had to repair the muscle again. Ever since then, I have double sutured the muscle and I have never had a problem again. It only takes about 5 extra minutes and can save you another operation. I have been told by several operating room nurses that they have heard a 'popping' sound when patients cough as they wake up after having a tummy tuck by surgeons who only do a one layer repair. This sound is due to the sutures breaking because of an inadequate muscle repair. Go for two!

Layers Of Stitches In Tummy Tuck Muscle Repair

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I always place two rows of sutures when performing the muscle plication portion of a tummy tuck, but this is a personal preference and I agree that a single layer can be suffient as well.

John Whitt, MD (retired)
Louisville Plastic Surgeon


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Both are acceptable and I have done it both ways. It depends on the person's tissue strength and I make the decision in the operating room. This type of question gets in to the technical side of the surgery and is not relevant to patients. That is, I am not going to give an option to a patient how I suture something, but certainly present them the options with respect to various treatments or procedures. Make sure you PS is board certified by the ABPS and look at photos of his or her results.

Muscle tightening technique

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Different plastic surgeons have different techniques they prefer for tighten the muscles in a tummy tuck (muscle plication).  I am not aware of any published data suggested any difference between a 1 layer or 2 layer plication.  Having said that, I do prefer a two-layer plication because it creates a reliable "backup" in case a single suture pops.  But as long as permanent sutures are utilized, you should be fine.   Hope this helps.

Dr. Basu

Houston, TX

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.