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

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.

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!

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.

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,

Dr.Bruno

I think you are referring to repairing the abdominal wall during the tummy tuck.  After pregnancy, the abdominal wall stretches out so that the abdominal muscles are not in the center of the abdomen anymore.  In my opinion, tightening the abdominal wall is an essential part of a tummy tuck.

 

I do this in 2 layers as I find that this is a stronger repair and I have not had problems with the looseness of the abdominal wall recurring.  Stronger and larger gauge sutures are used as the repair has to be very strong.

 

 

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.

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.

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

Dear Calif Mom,

Most plastic surgeons will use multiple layers to close an abdominoplasty incision.  Multiple may represent two layers of suture or even more.  The abdominal tissues are thick and multi-layered and every layer needs to be closed to withstand the tension on the closure-which in a tummy tuck can be a lot-and also close up any areas of dead space where fluid can collect and cause wound healing problems.  A single layer closure would put all of the tension on the outer layer of the skin which would result in a widen scar and other problems.  Best of luck with your tummy tuck.  

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!