Do I have an infection? What should I do? Spitting stitches after breast lift.

Question

I had a lift with 200 cc saline implant 15 days ago. I visited my PS yesterday bc I had concerns of fluid. He said I was fine. Did not remove my tape. Today, I noticed very gross yellow puss leaking through tape. Remove it to find raw skin. And 2 clear stitches poking out. PS didn't seem concerned, told me to clean and dry it. He also said to grab stitches with tweezers and pull and clip. I clipped but when I tried to remove them they were stuck and I began to bleed, no antibiotics. What 2do??

S. Larry Schlesinger, MD, FACS · Answer

All good plastic surgeons put many layers of sutures and dissolvable staples below the skin level in repairing most wounds on the body.  Putting dissolvable closure material below the skin level takes the tension off the suture line which gives the best chance of minimal scarring.   Secondarily, these subcuticular sutures therefore allow skin stitches to be taken out as early as three days which decreases the chance of cross hatched markings (railroad tracks).  Some plastic surgeons will close the skin layer with steri strips or super glue.  This has the advantage of not needing to take out skin sutures.  The unfortunate disadvantage is that, if the immediate subcuticular dissolvable sutures are too close to the skin surface, the body's white blood cells which dissolve these subcuticular sutures may make their way to the surface leading to what is known as a stitch abscess.  Stitch adscesses look for all the world like infection, but in reality, they are dissolving suture material, dying white blood cells, but no pathogenic bacteria.Steri strips and super glue, at times,  give these stitch abscesses a warm, enclosed moist area leading to more inflammation and again looking for all the world like a bacterial infection.  I totally agree with your surgeon that removing the tape and washing this area with soap and water pretty much cured half the problem.  The other half of the problem is that the undissolved suture material draws white blood cells to dissolve it, inhibiting wound healing.  If your surgeon used small 5-0 dissolvable sutures under the skin, then I totally agree this is something you can remove with a tweezers and scissors and speed the wound healing.  On the other hand, it this is 2-0 or 3-0 suture, I think you may need a surgeon's assistance to remove them completely so that your wound can heal.Every surgeon has his or her own paradyme about how to treat spitting sutures and wound healing in general.  If you were my patient, I would use the appropriate topical antibiotic (never Bacitracin or Neosporin) and twice a day dressing changes.  If you get ten plastic surgeons in a room and ask for the right way to treat your spitting sutures, you will get ten answers.  At this point, my recommendation is go with your plastic surgeon.  He or she knows exactly what was done.Happy New Year!

Gerald Minniti, MD, FACS · Answer

Hello,Based solely on what you've said, your surgeon is being very cavalier with your current status, and not having you come in immediately for this is suspect. Your wound could lead to an infection of your implants, a disastrous problem. You need to be seen. Best of luck.

Yucel Sarialtin, MD · Answer

hello, thank you for your question and sorry to hear your concerns.
I would recommend you to request an appointment with your surgeon and He will evaluate. please do not remove your stitches.
good luck.

Jed H. Horowitz, MD, FACS · Answer

HEALING AFTER BREAST SURGERY, AUGMENTATION, LIFTS1.    pain is variable2.    it takes 2-3 months for implants to settle and muscles to relax3.    celebrex, motrin, and muscle relaxers can help4.    massage and stretching may help5.    everyone heals differently6.    4-7 days off from work is commonHEALING OF SENSORY NERVES: Tingling, burning or shooting pains, which will disappear with time and should not alarm you, indicate regeneration of the sensory nerves. If these sensations cause pain, repeated, local self-massage helps.ASYMMETRY: The two breasts commonly heal quite differently. One breast may swell more, feel more uncomfortable, or have a different initial shape. After complete healing, they will be more similar and natural. You must have patience, but if this causes concern, ask questions of the doctor or the nursing staff.SHAPE AND CONTOUR: The final shape of your breasts will start to look its best approximately three (3) months after surgery. It takes time for the skin and muscle to stretch and relax around the new implant. The breast will often look higher, firmer, and “less natural” in the first three (3) months. It can take up to a year to see your final result.FOLLOW-UP EXAMS: These are generally done in 1 week, 2 to 3 weeks, 3 to 6 weeks, 3 months, 6 months to 1 year, and 1-2 year intervals. In our office we include all of your follow up appointments in the initial surgical fee.While it takes some time for both the implants and incisions to heal, your own plastic surgeon will have the best answers and solutions. It is unfortunate that you see a pus coming from the stitches because that is usually an indicator of an infection. It would be best to have the area examined to make sure that everything is going well or if additional work is needed for correction or revision. Good luck!

Vishnu Rumalla, MD · Answer

Thanks for your inquiry.  I suggest you set up an appointment and be seen by your surgeon.  Not all drainage is the same and best to let your surgeon evaluate, good luck.

Adam Tattelbaum, MD · Answer

Thanks for your question and sorry to hear about your concerns. Spitting sutures is not uncommon after a breast lift. It is usually easily treated topically. Give your PS a call and share your concerns.

Robyn Daugherty, MD · Answer

Hi Jammin' - 
It is not uncommon for sutures to cause an inflammatory reaction and spit through a closed wound.  While your wound is likely closed in multiple layers for the best possible scar, you should see your surgeon for evaluation of this.  The sutures will likely be removed and then wound care with topical antibiotic ointment done until the small openings are healed over.  
Best of luck!

Asaf Yalif, MD, FACS · Answer

I would recommend calling your plastic surgeon again and being seen in person for an evaluation. I would not remove/clip the stitches.Best of luck.

Steven Wallach, MD · Answer

I do not think that it is a good idea to pull out your own sutures. You are better off being seen by your doctor.

Peter Newen, MD - Account Suspended · Answer

Hello, Sorry to hear about the situation you are in. I suggest to contact your Surgeon immediately. Blood and pus are alarming and you need to be evaluated in person. We wish you the best of luck!

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