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.