Can the permanent sutures used in diastasis recti repair (during a full tummy tuck) fail after two years?

Question

I had a full tummy tuck in April '15 due to twins. He used permanent sutures to repair my muscles. One year after surgery I developed a hernia an inch above my belly button. I saw my plastic surgeon about it immediately and was told we would just "watch it" despite the fact that I could push it in and out. Upon seeing a surgeon yesterday due to some new pain near my hernia site, I was told I not only have a hernia but i have diastasis again as my lower sutures failed. I am not abnormally active.

Juan Carlos Fuentes, MD · Answer

The suture material for the muscle repair usually is non absorbable, so the suture can hold the tissues long enough while the scar tissue gets strong to hold the muscle in place. In some patients that have had a lot of stretching in the abdominal wall such like a twin pregnancy, the muscles on the abdominal wall will not have the best strength and the fascia may be very weak so even a small amount of stress over the muscles, may create a hernia or the  diastasis may recur. In those patients the use of a mesh may be needed to hold the repair, but this will be a decision of the surgeon either prior to the surgery or during the surgery.

Joyce C. Chen, MD, MPH, FACS · Answer

Thanks so much for your question!   Permanent non-absorbable sutures are usually used for plication of the rectus muscle.  Sometimes, overexertion or muscle fascia weakness can lead to sutures breaking or popping.  However, for this to happen two years after the plication is not as common, though you can certainly develop a recurrence of your diastasis or weakness in your fascia or even a true hernia with an actual defect in your muscle fascia.  Hope this helps...best of luck!
Sincerely,
Joyce C. Chen, MD, MPH, FACS

Farbod Esmailian, MD · Answer

It is very unusual to have "failure" of the sutures 2 years out.  At this point the body have healed and it really is not relying on the sutures any further.  The fact that you have a hernia and diastasis is certainly unusual.  I would ask if you have had any weight gain or excessive weight loss during the past 2 years, as that would contribute to the issues at hand.The tissue can certainly stretch over time and lead to a diastasis once again but there usually has to be something that caused it, such as body changes like I mentioned.Hope that helps.

Daniel Barrett, MD · Answer

Dear Scarlett James,permanent sutures don't guarantee that your diastasis will be corrected and that you won't have any complications in the future. In some cases, a hernia or diastasis can occur again. In that case a revision surgery might be needed.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery 
Member, Am. Society of Plastic Surgery

Steven Turkeltaub, MD · Answer

After around 3 months or so, the sutures for the diastasis repair become irrelevant - unneeded. The tissue has enough strength that the repair no longer relies on the sutures. In your situation, there can be at least 3 possibilities for why this developed: 1.) the repair around the belly button didn't extend close enough to it, leaving a weakness still present for the hernia to develop 2.) the was an early disruption of the repair, possibly within the 1st 8 weeks which was not detected but is more evident now for many reasons 3.) your tissues as related to the repair did not heal with enough strength to resist later strong intra-abdominal forces.Regardless, now it sounds like you need to be fully evaluated and have your hernia appropriately repaired.Steven Turkeltaub, MD

Curtis Wong, MD · Answer

are done with both permanent and dissolving sutures as the scar that forms while healing is what is really holding the muscle together.  Sutures can fail early in the healing process and this is usually quite obvious to the patient and surgeon.  As for the hernia, if its there, its advisable to have it repaired.  And as for diastasis returning, if your quality of tissue is poor and stretched out (aka attenuated), you could develop a laxity again but is unlikely due to your previous repair.

Arian Mowlavi, MD, FACS (license on probation) · Answer

Suture failure is not your problem; only two months following your muscle repair, the fascia fuses and is fail proof; This is why some plastic surgeons actually use Vicyl for this repair which only lasts one to two months even when larger gauge thread is used. What has happened is that you may have developed a hernia (an actual tear in the muscle) as well your muscles were actually thinned out and the remaining muscles have thinned out; This is an important distinction and will require you not to have a revision of your suture line, but you need to consider the TRI Modality muscle repair which requires direct repair + bilateral component separation + Xenograft onlay repair.

Can the permanent sutures used in diastasis recti repair (during a full tummy tuck) fail after two years?

Answers (7)

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