Very slim & very active - permanent vs dissolvable sutures, mesh/no mesh?

Thank you for posting your question here!My answer will be based on the limited information provided, for a detailed and personalized plan I would recommend that you consult with your plastic surgeon.
From my understanding of the question it sounds like you are asking about diastasis repair and muscle plication. Different surgeons have different opinions on what to use in terms of absorbable vs permanent stitches , I personally use permanent as I believe it decreases recurrences and issues in the future , I do perform a two layer repair ( two layers of sutures) and in very slim patients I might use an absorbable suture for the top layer as in certain very slim patients you might be able to feel the knot so in that case it will be absorbed after a few months. Whatever your surgeon decides on the type of suture will not affect your mobility. As for mesh , I rarely use it during plication unless I notice the abdominal wall is very weak and loose , in that case I use it for re-enforcement , meshes are also used when a large hernia is repaired.I hope this helps, best of luck!

The type of sutures used probably do not have any significance on your final result. It is usually just a doctor's preference. This would not have any effect on your postoperative activity. Mesh is almost never needed except in very special situations. Normal tummy tucks do not require mesh.

Thank you for your question regarding the use of permanent versus dissolvable sutures for your abdominal muscle repair. Based on your description, you are a very slim and active individual with a 4cm diastasis recti (muscle separation). Your concern about how the choice of sutures will affect your mobility and ability to engage in your dynamic activities, such as dancing, boxing, and yoga, is valid.

Permanent sutures are preferred for muscle repair because they provide a long-lasting, durable hold to bring the rectus muscles (your abdominal muscles) together. This ensures that the repair remains stable over time, even during high-impact activities or exercises that engage the core. They are especially effective for patients with larger muscle separations or those who plan to maintain an active lifestyle post-surgery. Permanent sutures do not usually restrict movement or flexibility after healing is complete, as the body adapts to the new tension in the muscles. I ONLY use permanent sutures on muscle plication.

Dissolvable sutures, on the other hand, gradually lose their strength as they dissolve over time. While they can also be effective, there is a slightly higher risk of the muscle repair weakening or even separating again in highly active individuals or those engaging in strenuous core exercises. For someone as physically active as you, permanent sutures may be the better option to ensure a robust and durable repair.

As for mesh, it is generally not necessary in your case. Mesh is typically used for very severe diastasis recti or cases where the abdominal wall is extremely weak, which does not appear to be your situation. Without mesh, you’ll likely have a more natural feel to your abdominal wall post-repair.

In terms of mobility, bending, stretching, and twisting after recovery will not be restricted by the use of permanent sutures. The initial tightness you feel post-surgery is due to the muscle repair and healing process, not the sutures themselves. Over time, as you recover and regain strength and flexibility, you should be able to return to your active lifestyle without limitations.

It’s great that you are discussing these details with your plastic surgeon. Make sure you express all your concerns so they can tailor the approach to your specific needs. With proper healing and a gradual return to activity, you should achieve both the aesthetic and functional results you’re hoping for.

Sincerely,
Dr. Katzen

Hi, thanks for your question. It is not the sutures that provide long-lasting strength to the repair, it is the scar tissue that forms as a result of suture placement that will hold things in place for the long-term. The sutures are simply placed to aid this process in the short-medium term. For this reason, for divarication repair, I routinely use sutures that dissolve (but not for several months), and would not typically use a mesh.
Using permanent sutures should not impact the extent of the ‘tightness’ as any suture will stretch and relax to some extent with time, even if permanent.

Great question. Your muscle separation is likely a big issue for you. Muscle repair is key to a great result. You certainly want PERMANENT sutures as dissolvable sutures will lead to laxity of the repair and compromise your result. Once healed this will not impair your athletic ability.

This is an excellent question! To start with, your 4 cm muscle separation is fairly common as a result of pregnancy. In cases like this, the separation is brought together and permanently closed with sutures after elevating the skin during a tummy tuck to expose the area.

The fascia (the strong layer covering the muscles) is typically strong enough to hold the repair without needing mesh. The key is ensuring the sutures remain in place long enough for the fascia to heal securely. Healing strength reaches about 80% by three months and plateaus between six months and a year at 80–90%.

Both permanent and long-lasting dissolvable sutures are used in these repairs. The choice typically depends on the patient’s specific circumstances. Permanent sutures ensure a durable repair, while long-lasting dissolvable sutures provide support during the critical healing period and eventually dissolve once the fascia is strong enough.

For slender patients like you, permanent sutures can sometimes be felt or seen under the skin once swelling subsides, potentially causing irritation or discomfort. In your case, long-lasting dissolvable sutures may be the better option, as they would provide the necessary support while minimizing the risk of visible or palpable knots.

Dr. B

Dear Passionate606644,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

4 cm is a large separation and surgeons usually use permanent sutures. If you are not planning future pregnancies, I recommend abdominoplasty with mesh reinforcement. The mesh creates a more hourglass figure by compressing the abdominal wall resulting in early satiety and helps maintain a reduced weight.

Best Wishes,

Gary Horndeski, M.D.

Your questions does not indicate what procedure you are referring to. If you are referring abdominal muscle separation and abdominoplasty, then your questions about using a mesh is irrelevant. Mesh is used by general surgeons for hernia repair when the abdominal wall is weak or has had multiple previous operations. For a regular abdominoplasty, permanent sutures are used to bring the muscle that have been stretched apart during pregnancy.

I use permanent sutures for the diastasis repair and my patients include athletes, trainers and other professionals. Please see my Instagram for some photos.
It is important to not only put together the 4 cm 'width' separation but also the 'up and down' spread from the pregnant uterus. Feel free to contact me for references to articles about this.