TT with Double Plication for athletes -- is it better than single plication?

Doctor Answers 14

TT with Double Plication for athletes -- is it better than single plication?

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I would not focus on what is proclaimed as better.   The considerations in creating the best result are manifold and do not lend themselves to easy interpretation.  Find a surgeon who performs this surgery hundreds or thousands of times and has demonstrated prowess.

Kenneth Hughes, MD

Los Angeles, CA

Is double plication better than single plication in TT?

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Unfortunately, I think someone is trying to tell you that they do a better TT because they do this and that! Don't be fooled by this sales talk. Most plastic surgeons, if they do a plication, do basically the same. I would probably stay away from that plastic surgeon salesman!

Edward J. Domanskis, MD
Newport Beach Plastic Surgeon
4.5 out of 5 stars 28 reviews

Abdominoplasty plication technique

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There's no evidence to suggest "more is better" for abdominoplasty suturing of the rectus muscles. In fact, the literature from hernia surgery suggests it's expected to do worse. More sutures, particularly permanent ones, 1) reduce the blood flow to the tissue in the zone of healing, and 2) permanent suture material seems to be more likely to cause small tears in the abdominal wall over time. The traditional 2-layer fascia plication technique with heavy sutures has been abandoned by many surgeons and plastic surgeons for these reasons for a continuous single layered technique (with either unbraided permanent or slow absorbing material) which has demonstrated the best balance of strength and wound healing over time

Double plication in a TT

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Most surgeons will plicate the rectus fascia with a few layers of sutures.  Plicating more than that doesn't necessarily give better results; it just causes the fascia to rip.

A far more important distinction, especially in athletic patients who did not have a large weight gain during their pregnancies, is the availability of less invasive tummy tucks.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 195 reviews

Abdominal muscle tightening

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I find it best to always perform a double layer plication to the abdominal wall. Abdominal  core strength can be significant and with any exertion of these muscles the sutures can be pulled apart. A double layer  closure ensures greater strength to your repair. I place a central, abdominal double layer closure; but I also utilize double layer closures throughout the abdomen wherever there may be looseness in the abdominal wall fascia. I always like to optimize shaping of the fascia to create an hour glass figure. Make sure you see someone that has extensive experience in abdominaplasties.  

Sean T. Lille, MD
Scottsdale Plastic Surgeon
4.6 out of 5 stars 33 reviews

Tummy tuck and plication

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During a tummy tuck, the abdominal muscle fascia is usually plicated to tighten your core and reduce the amount of laxity and "pooching" that occurs at the belly. A double plication is often used by plastic surgeons for extra security but single plications are also very successful when done correctly. Regardless of the plication, I recommend to my patients that strenous exercise be avoided until 4 weeks after surgery after which time you can build back up to full exercises depending on your comfort level. Ultimately, it is up to your own tissue strength and scar formation after healing to maintain the tightness. The sutures are meant to simply hold the tissue together until your own healing tissues takeover. Hope this helps!

Johnson C. Lee, MD Plastic Surgery

Johnson C. Lee, MD
Beverly Hills Physician
5.0 out of 5 stars 17 reviews

TT with Double Plication for athletes -- is it better than single plication

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That depends on what you are calling a double plication. If what is meant is that there are two layers, that might hold the muscles together better for about 6 weeks. After that,the repair depends on tissues healing properly rather than the sutures. Care needs to be taken to not pull them muscles so tight that they are invaginated as that disrupts the angle of the muscles and can make them in-efficient

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews

Muscle Plication

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You may be the victim of the internet, both with it's over abundance of misinformation, simultaneous with it's ability to give detailed information that can't be adequately processed by the general public. There is nothing in the plastic surgery literature about 'double plication' of the rectus fascia with regards to it's application to athletes. That's because our goal is to perform individual tasks within a procedure, e.g. rectus plication during a tummy tuck, that is maximally effective and durable in every patient. How this is accomplished is a surgeon preference, based on training and experience. In my hands, the rectus fascia is plicated with individual stitches to near maximum tension. Then a second stitch is run from top to bottom to smooth out the contour along the entire abdominal wall; this is done for cosmetic purposes, not increased durability. In fact, we know from the general surgery literature that too many sutures can lead to a break down of a repair due to diminished blood flow to the area being repaired. So, all is not what it seems in medicine and surgery, especially when complex information is being given to a lay person. My recommendation is to visit a few ABPS certified/ASAPS member surgeons that have been doing tummy tucks for decades. Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

TT with Double Plication for athletes -- is it better than single plication?

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You will find that each surgeon has developed his/her own technique based on experience.  I feel it is most important to obtain a firm tight closure using interrupted rather than running sutures and sometimes add a second layer if I feel greater support is needed.  The end goal is to make sure that the upper and lower abdominal fascia are equally tightened and strong regardless of the technique.  Be sure to give yourself enough healing time before stressing your abdominal muscles and best wishes for a good result.

Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 34 reviews

Muscle Repair

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Thanks for your inquiry, many plastic surgeons routinely perform a double layer muscle plication on all patients. Ask during consultations how each surgeon performs the surgery, and good luck.   

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.