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

The dissolvable sutures will not hold long enough for the muscle repair to heal. Mesh is usually not used for just a separation. Even with the tightened muscles, once healed, you should be able to do your activities.

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.

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