What is the preferred choice for internal sutures for a tummy tuck, permanent or absorbable?

Question

Specifically for a diastasis recti muscle repair? Are there long term side effects of having permanent sutures?

Anita Patel, MD, FACS · Answer

Each surgeon has her/his own preference. Personally I like to perform the diastasis repair in 2 layers, using a permanent suture for the deeper layer, and slowly absorbing suture for the second layer. In theory, even if absorbable sutures are used, the body is thought to scar in the repaired position before the sutures absorb. However, in patients who may stress the repair with early activity, or aggressive activity, or weight changes while the area is healing, I want to have one row of permanent sutures to prevent the repair from widening or the diastasis from recurring. There is not generally any long term side effect of permanent suture, though one potential risk of any suture is infection of the suture. Given there is typically something else that causes infection and gets trapped in the suture material, by doing the first layer repair in a "buried" suture technique, I leave very little of the suture exposed to the surface. Then by placing a second layer of sutures, the entire row of permanent sutures is "buried" from the surface of the repair, or isolated from exposure to the adjacent tissue. Aside from what type of suture is used, the technique of diastasis repair is also a consideration, as is the overall tummy tuck planning and technique, and peri-operative care and post-operative care, so this question should be just one of many considerations.

William Andrade, MD · Answer

Hello, there are many accepted ways to perform a rectus diastasis repair.  I have had good outcomes using a multi-layer closure; the first layer with interrupted absorbable sutures (Vicryl) followed by another layer of slow-dissolving barbed sutures (Stratafix) that hold the tissue securely.

Vishnu Rumalla, MD · Answer

Thanks for your inquiry, I close the muscle in two layers.  The first layer is made of interrupted permanent suture, the second layer is a running slow absorbing suture.  Both type of sutures are used often with minimal problems.

Jeffrey D. Wagner, MD · Answer

This question is a good one, and there are probably many answers, none of them wrong.  In short, this is typically determined by your surgeon's preference and experience, so I'd ask him/her.  My own preference has evolved over time, and I currently use a long lasting, but slowly absorbable running suture reinforced with some interrupted sutures to tighten the abdominal wall during abdominoplasty.  Over several months, these sutures dissolve and by then the muscles will have scarred together enough so that a permanent suture is not needed.  Permanent sutures may be more likely to become infected and knots may cause palpable lumps in some thin patients.  The biggest issue with permanent sutures is that they are theoretically not necessary.  Sutures will not keep tissues together over time in the absence of adequate wound healing, so I don't use them often.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your
question.  I prefer to use a combination of permanent and absorbable sutures for the diastasis repair.   If you are an appropriate candidate for a tummy tuck, this can be done
through a low and short incision, all completely below the bikini line.  The belly button can be designed to look
natural and have no scars on the exterior.  
Your muscles can also be plicated resulting in a flat abdomen.  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 with a qualified board-certified plastic surgeon who can evaluate
you in person.
Best wishes and good luck.
Richard G. Reish, M.D. FACS
Harvard-trained plastic surgeon

John Silverton, MD, FRCS · Answer

I agree with most of the answers. It probably does not matter which type of suture is used in the long run - just as long as the suture holds the tissues in place long enough to get a firm closure with scar tissue. My preference is permanent sutures because the absorption rate of absorbable sutures may vary a lot in different people. It takes quite a long time to get firm permanent scar tissue in place that will withstanding the stress of exercising - maybe 2 to 3 months.

Vasdev Rai, MD · Answer

It is not suture that matters. It is the surgeon that matters. Absorbable as well non absorbable sutures are used for diastassis repair. Long term effect comes from body tissues healing in sutured place and not the suture material. Permanant sutures, after healing just lay there without adding to strength to repair. Healing of tissues gives the strength to repair.

Steven Wallach, MD · Answer

I prefer to use permanent but there probably is no difference between the two in terms of maintenance of the result.

Mark T. Boschert, MD · Answer

It really does not matter.  For example general surgeons who operate on the internal structures of the abdomen such as the bowels will open the abdominal wall completely to see all of the internal organs. When they close the abdomen they often use absorbable sutures and yet that repair of the complete separation of the abdominal wall stays together in those patients for the rest of their lives. So, we learned that absorbable sutures work without any problems. On the opposite side of that, patients have also had full repair with permanent sutures after an abdominoplasty and yet can become pregnant after that and they will still stretch out completely for the baby. Once again showing that it does not matter if you use a permanent suture or an absorsable suture, the strength of the repair is the strength of your scar tissue.  All that being said don’t worry about the sutures. Most of us will use a combination of both but in the end it probably makes no difference whatsoever to you. The most important thing for you should be to find a board-certified plastic surgeon who is well-versed in this operation and can give you the results you’re looking for. Best of luck, Dr. Boschert

Erika Sato, MD, FACS · Answer

There is no correct answer to your question. This is definitely the surgeon's preference. Some say permanent are better because there is less chance of recurrence of the diastasis, but permanent sutures can be rejected by your body causing infection (abscess) and/or suture spitting (the suture pokes through your skin as your body rejects it). Absorbable suture rarely spit or cause abscess but they do break down over time. The thought is that your muscles scar together before the suture breaks down.

What is the preferred choice for internal sutures for a tummy tuck, permanent or absorbable?

Answers (13)

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