Protruding Sutures after Tummy Tuck 4 Years Ago (photos)

Question

I had a Tummy Tuck about 4 years ago followed by liposuction 2 years ago (same surgeon). After the liposuction I noticed some sutures poking out from under my skin which were removed via incision. As I've gotten leaner, more and more are starting to poke out. I can't get a straight answer from my surgeon. Is this normal? If so, why was I never told about this as a possible side effect? Or is this due to poor suture placement? Any insight would be greatly appreciated.

Daniel Barrett, MD · Answer

Dear mled,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Casey Anderson, MD, FACS · Answer

It looks like you have gotten so lean that things that aren't normally visible now are. I don't think it's poor suture placement. I think you weren't told because very few patients are able to get a fit as you currently are. My recommendation is to get your surgeon to address the issue.

Camille Cash, MD · Answer

The permanent sutures can be removed by your surgeon, as the ones prior were.  This is not a common issue for patients after a tummy tuck as most do not become as lean as you.  I encourage you to discuss your concerns with your surgeon.

Douglas Taranow, DO, FACOS · Answer

Your abdominoplasty appears to be done very well.  The fact that you lost weight and now the permanent sutures are visible/palpable is of some concern.
Tightening (plicating) the fascia covering the muscle to tighten the abdomen is an integral part of an abdominoplasty.  I usually bury my knots (stitch them to be upside down pointing inwards or suture tissue over them to cover them from the skin).  It appears you are correct that your suture ends (knots) are both visible and palpable.  The only solution I can think of is to remove them under local anesthesia ('Novocaine') through small incisions.
Best wishes.
Dr. Taranow

Gilbert Lee, MD · Answer

Thank you for your photos and questions. During a tummy tuck numerous different types of suture are used. Based on the amount of time from your tummy tuck, it is most likely permanent sutures were used. I recommend scheduling a consultation with a board certified Plastic Surgeon who can assess you in person but most likely the sutures will need to be removed. Its always best to first go back to the surgeon who did your case as they know exactly what was done. If there are still concerns, get a second opinion. Good luck!

Richard R. Orr, MD · Answer

I have seen this rarely. There is a suture technique used called Progressive Tension Sutures, that are placed during a tummy tuck, between the soft tissue above and the muscle underneath to help close this space down. When I have seen this, it is with sutures I place that dissolve over a year or so. I question whether your doctor used permanent sutures here. The thinner you are the more likely they will be seen. If these are permanent sutures, they may have to be removed through a small incision over each one. Check with your surgeon or get a copy of the operative report. That hopefully will answer your questions.Good luck

Darryl J. Blinski, MD · Answer

The questions that I have are: Did you have a drain less TT with progessive sutures? Appears permanent suture instead of dissolving sutures were placed? Only directed incisional removal of each retained suture can eliminate the effect.

Mark Eberbach, MD · Answer

The issue is permanent suture showing under your skin. This is not a common problem because few patients ever get as lean as you. It is certainly common enough though.

You weren't told in specific terms because it isn't possible to detail absolutely everything. It is no doubt covered in your consent in less specific terms.

The knots can be removed.

Mats Hagstrom, MD (license on probation) · Answer

Permanent sutures are frequently used for a tummy tuck especially for muscle tightening.

Most patients have sufficient subcutaneous fat that these do not represent an issue. I don’t know how much fat you had during the tummy tuck but it now appears that you are quite lean and that is showing your underlying muscle fascial contour.

Surgeons usually leave a short tail at the end of a tight knot on a stitch for safety reasons and may occasionally modify hiding the night if placing sutures very close to the skin. At the time of the procedure I don’t think your surgeon was or needed to be worried about this. I don’t think surgeons typically mention this during consultations because it is a fairly infrequent problem.

It doesn’t look like there are that many Sutures involved so if they are of concern perhaps have your surgeon number of the skin and pluck out the ones that bother you.

Most patients don’t lose that much weight after the procedure.

What to discuss during a consultation should be based on the consequences in relationship to the prevalence.  In other words serious complications even though they’re not common should be discussed because they are serious and common complications should be discussed because they happen fairly frequently.  conditions that are unlikely and don’t have serious consequences create information overload during consult.

Each surgeon has on a way of what to discuss but it’s not possible to bring up all theoretical ponsible outcomes. Even if it had been mentioned would that have stopped you from having the procedure?

The chance of this happening is fairly uncommon but for you it’s 100%.

Follow up with your provider who sounds like he’s doing the right thing.

Best,

Mats Hagstrom MD

Jeffrey C. Hamm, MD - Account Suspended · Answer

Hi and welcome to our forum!
On occasion, a patient will present with a similar picture...lumps and bumps localized to underlying suture material after abdominoplasty. This most likely represents an allergic reaction to the suture material or a low grade infection which has colonized the suture. 
Treatment consists of obtaining a culture of any drainage (if any), appropriate antibiotic coverage (if required) and removal of the offending suture(s).
This complication has nothing to do with the placement of the sutures. 
Continue follow up with your plastic surgeon.
Best wishes...

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