Suture granuloma at muscle repair. Will this compromise the muscle repair?

When we perform muscle repair (rectus plication), we essentially bring the rectus muscles together with strong sutures. As these muscles stay in this new position during healing, fibrotic tissue forms, and this scar tissue helps hold the muscles together in their corrected alignment.
If during the early healing phase (first 6 weeks), the sutures are not disrupted by constipation, coughing, heavy lifting, or early exercise, the repair is usually successful. After this 6-week period, once fibrosis has developed, the sutures themselves are no longer critical—it's the scar tissue (fibrotic healing) that keeps the muscles in place.
Therefore, complications like granulomas, infections, foreign body reactions, or seromas occurring after this 6-week window are much less likely to affect the integrity of the muscle repair.

Thank you for your question. If you are 2 years out from your tummy tuck, the suture can be removed. What you are feeling is the suture knot, and this can be removed. The diastasis repair is well healed, and the suture knot can safely be removed.

Early in my career I used permanent stitches to plicate the muscle on abdominoplasty's. I did see a rare occasion where somebody got a suture granuloma around 1 of the permanent stitches that needed to be removed. This did not affect her muscle repair.
Later in life I switched to absorbable sutures to avoid the suture granuloma problem. After the area has healed he should not have any problem as the muscle is fused together as the healing process goes on. The sutures then resorb and I have not seen a recurrence of a diastases since switching to the absorbable sutures.
Good luck,Dr. T

Hello and thank you for the question! You have many sutures under the skin and permeant ones as well. The fact that you are two years out and this is causing you problems I would recommend to just remove that one area, or one suture. I have had to remove sutures from a few of my patients in the past due to the same cause and they are healing well. Best of Luck!

I'm guessing that your plastic surgeon is indicating that your rectus abdominal muscle plication was performed with a permanent running suture and that it is still supporting the closure of he muscle. This is one of those things that plastics surgeons debate but there is good evidence that after 2 years your body has heal itself together in a way that removal of the suture should not compromise your results. My answer is based on a standard tummy tuck with a standard plication as I described but is possible that your plastic surgeon knows something about your individual case.

Your muscle repair is no long strictly dependent on the sutures. You have scarred down around the repair, and that is likely enough to keep things together. Best wishes on your surgery!

it has been shown that the muscles can be tightened with an absorbable suture which lasts about six months. By this time, the muscles are well healed and the sutures aren't needed any longer. If permanent sutures are used, they can often be found just sitting loosely, after they had done their job. Plastic surgeons have different ideas about this and it is often best to follow your plastic surgeons advice.

Thank you for your question and congratulations on your weight loss and success! Stitch-related granulomas are common after abdominoplasty, unfortunately, and are usually seen where we've made knots. Removing it may indeed affect your repair and results. You should listen to your plastic surgeon.

A suture granuloma is a localized inflammatory response that can occur in response to a suture material. Granulomas are small, nodular formations of immune cells that can develop around non-absorbable sutures. While suture granulomas are generally considered a benign reaction, their impact on muscle repair depends on the specifics of the situation.

Here are some considerations:

Location and Size: The location and size of the suture granuloma matter. If it is small and away from critical structures, it may not compromise the muscle repair significantly.

Inflammatory Response: Suture granulomas typically represent the body's response to a foreign material. In some cases, this inflammation may resolve on its own over time. However, persistent inflammation could potentially affect the healing process.

Consult Your Surgeon: If you suspect a suture granuloma or are experiencing symptoms, it's crucial to consult your surgeon. They can evaluate the situation, determine the cause of any symptoms, and decide on an appropriate course of action.

Imaging Studies: If necessary, imaging studies such as ultrasound or MRI may help assess the extent of the granuloma and its impact on the surrounding tissues.

Revision Surgery: In some cases, if the suture granuloma is causing issues or if there are concerns about the muscle repair, revision surgery may be considered. This involves addressing the granuloma and any associated issues.

It's important to note that any complications related to muscle repair should be taken seriously. If you are experiencing pain, swelling, or other symptoms, seek prompt medical attention. Your surgeon will be in the best position to assess the situation, recommend appropriate interventions, and ensure that the muscle repair is not compromised.

As with any medical concern, this information is general and not a substitute for professional medical advice. Consult with your healthcare provider or surgeon for personalized guidance based on your specific situation.

If you developed an issue with a sure in the acute post operative phase of recovery and remove one of the plication sutures less than 3-6 months after the procedure it could compromise the results because your body hasn't been able to form strong scar tissue keeping the muscles together but after two years I would be surprised if your muscular plication was effected by a suture removal. As always, it's best to consult with your surgeon because they may have additional information about your case that is leading to their recommendation. Wishing you the best.