What are the pros and cons of having "dissolvable" sutures for the vertical wall for the TT procedure? (Photo)

Question

5/6 PS I've consulted with all use Permanent sutures for the internal wall for their TT procedure. But a PS I am considering saids he will use an dissolvable one. He said the scar tissue healing around the wall where he will place the sutures will hold it in place like a corset, making the permanent sutures not necessary. Pls share your thoughts and experiences.

Farbod Esmailian, MD · Answer

I have been using permanent sutures for over 10 years and will likely not switch to absorbable any time soon.  The one draw back with the permanent sutures is that they may extrude (push thru) the incision or around the belly button over time.  It is a rare instance but it can happen.  The problem with the absorbable sutures is just that, they absorb over time.  Some longer lasting ones (like PDS) may stay around longer, about 6 months or so, but they do lose strength over time.  In fact with PDS only 60% of its strength is available at 6 weeks. Therefore, you can see even with the longer lasting absorbable sutures, the strength (in my mind) is not sufficient for a tummy tuck repair.Hope that helps.

Ramin Behmand, MD, FACS · Answer

The main advantage of using dissolvable sutures to repair the muscle separation in a tummy tuck is in patients who are very lean. In those patients, the permanent suture may become palpable, or even visible, after they heal.  The dissolvable sutures address this problem. The type of suture used needs to last long enough for complete healing of the muscle fascia repair, which is at the minimum around 8 weeks. The ideal suture therefore should last 3-plus months. Dr. B.

Jacob G. Unger, MD · Answer

Thank you for your question. Most of our literature within plastic surgery indicates that absorbable sutures for midline plication is an effective option. The temporary suture holds the abdominal wall together while it is healing. In general, as long as the temporary suture is present long enough for that healing to occur, the results will still be permanent. That said, there is always the risk of sutures tearing, breaking, or widening whether or not permanent suture is used. I would rely on your surgeon's judgment and his or her personal results as an indication of whether or not temporary suture is a good option for you. Thank you

Bernabe Vazquez, MD · Answer

A great question and one that i'm sure every plastic surgeon has struggled with or at least considered.I started my career like most surgeons using permanent sutures to approximate the rectus muscles. They are fast and effecient to use and what i had been trained with. Then one day a patient returned to my office with a reaction to the suture material which required that I make a small incision to remove. A small scar resulted.  A few months later she returned again with the same problem. Another suture removal and another small but visible scar. This continued for the next 18 to 24 months approximately 4 or 5 times. Ten years later the patient came back again, very happy with her abdominoplasty but with another suture "spitting" from the midline. Once again it required removal under local anesthesia and a resulting scar. The lesson here is that permanent sutures are permanent and reaction to them which does happen will be a  permanent possibility. The result is that I have been using strong absorbable sutures for the last 15 years and believe they do the same thing as the permanent ones without the long term concerns. I agree with the surgeon that told you that absorbable sutures create a layer of scar tissue that holds the repair together.

Gurmander Singh Kohli, MD, FACS · Answer

Thank  you for writing to RealSelf.The absorbable sutures for the deep fascia generally do not last long enough for the healing of the scar tissue is strong enough. I have always used non absorbable sutures for the deep fascia in TT cases.

Robert S. Houser, DO · Answer

Personally, I have been using permanent sutures for 14 years, but I'm now switching to dissolvable.  It doesn't happen often, but those permanent sutures sometimes get infected, even years down the road.  If that happens, they need to be removed.When using a dissolvable suture, I now use one called PDS (there are others like it) that actually takes 6 months to go away. In that time, your body will create the scar tissue needed to hold your belly together.  Good luck!

Robert A. Hardesty, MD, FACS - Account Suspended · Answer

Dear Ms. Lyndaaa,Thank you for your question.Pros:Absorbable sutures will absorb and not "spit" (come to the surface), get infected or form a sterile abscess Permanent will theoretically provide long term strength Cons:Absorbable sutures theoretically will not provide the long term strength of permanent sutures.Permanent sutures can "spit" (come to the surface), get infected or form a sterile abscess.My personal experience is that absorbable sutures provide the strength needed while  the scar tissue is forming for a permanent bond to occur while obviating the long term problems of permanent sutures. I thus recommend and only use absorbable sutures for the rectus muscle plication.I trust you will choose  a experienced Plastic Surgeon who is Certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).
My best wishes,Dr. R. A. Hardesty, MD, FACSDiplomate and Certified by the Am. Bd. of Plastic Surgerywwww imagineplasticsurgery.comAwardee: RealSelf Top 1004646 Brockton AveRiverside, Calif 92506Office 951 686-7600Fax 951 369-9999

Jon Ver Halen, MD, FACS (license suspended) · Answer

Hello and thank you for your excellent question. In general, I use a permanent suture on the abdominal wall because we don't want the muscles to pull apart again after the surgery. Of course, you will need an in-person consultation to evaluate you for this procedure. Preoperative visualization and surgical simulation with the Crisalix system may help with your decision. Any treatment plan should be based on a detailed discussion with equal input from both you and your surgeon.    Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation in person with a qualified board-certified plastic surgeon. Good luck!
 
 Best,
Jon Ver Halen, MD FACS
 Harvard educated plastic surgeon

Jon A. Perlman, MD (retired) · Answer

With 35 years of experience I always use a permanent stitch to avoid jeopardizing the tightening of the abdominal wall.  I think that there is little to gain with the use of an absorbable suture.  Best wishes for a successful surgery.Jon A Perlman MD FACS 
  
Certified, Am Board of Plastic Surgery 
  
Member, Am. Society for Aesthetic Plastic Surgery (ASAPS) 
  
Member, Am. Society of Plastic Surgeons (ASPS)
  
Beverly Hills, Ca

Ronald V. DeMars, MD (Retired) · Answer

As long as the sutures hold their repair solidly for a minimum of 8 weeks, there should be no problem. Unfortunately that cannot be guaranteed with any of the dissolving sutures, even the slowly dissolving ones, because their strength deteriorates over time. If that were the case you wouldn't see the huge majority of surgeons using permanent sutures. The risk of permanent sutures is an infection. I have seen that 3 or 4 times in over 30 years so the risk is miniscule.

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