Stitches Did Not Dissolve After Breast Reduction?

It’s not unusual to use long lasting absorbable sutures when performing breast reduction surgery.  These sutures typically last six to nine months, and are buried beneath the skin.  They are used in an effort to avoid spread of the scar.  They provide support to the wound closure, until the wound has gained adequate strength.
Occasionally these sutures work their way through the skin before they can absorb.  When this happens, it’s not unusual to develop an infection around the stitch.  This can result in a stitch abscess or granuloma.  This is the pimple you describe.
This situation usually requires drainage of the abscess, removal of the suture remnant and possibly antibiotics.  This is a relatively simple problem to deal with if treated early.  If diagnosis and treatment are delayed, then more significant problems can result.
It’s not unusual to have absorbable sutures protrude through the skin following breast reduction surgery. With appropriate care this should represent a minor problem with no long term consequences.  If you have protruding absorbable sutures, follow-up with your plastic surgeon is indicated.

Sometimes dissolvable sutures may work their way through the skin before they dissolve completely, causing irritation or small bumps. If you're experiencing pain and notice a stitch that hasn't dissolved, your surgeon may need to remove it, as they did during your visit. While there isn’t much you can do to speed up the dissolution process, it’s important to follow up with your surgeon if you notice any new or recurring discomfort, redness, or visible stitches. In some cases, the body may push the sutures to the surface, resulting in an abscess or pimple-like appearance, which can be addressed with minor intervention. Keep your surgeon informed of any changes, especially if you experience signs of infection, such as increased redness, warmth, or discharge.
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

Hello and thank you for your question!
You should see your surgeon again to have it removed. This may continue to happen, it is not uncommon. Contact your surgeon with any concerns. Best wishes!

Although I am a fan of dissolving sutures sometimes the knots are too close to the skin and they spit out and cause an abscess.  This is usually because the enzyme level close to the surface is not as strong to disintegrate the material used for suturing.  I use Vicryl sutures for most of my closures and very rarely get a suture abscess due to burying the knots deep below the dermis in the subcutaneous fatty layer.

You are having a reaction to your stitch or a small stitch abscess. This happens more commonly with non-absorbable sutures but happens with absorbable sutures as well. 8 weeks after surgery there are still sutures that remain that have not fully dissolved, and that appears to be your case. There is nothing you can do to make them dissolve faster. If they become problematic they can be dealt with as your surgeon did.
-Dr. David Mattos, New York Plastic Surgical Group

This is common in a breast reduction.   There are hundreds of stitches placed in a breast reduction.  Sometimes before they dissolve, your body can push them to the surface of the skin.  If this occurs, they can be pulled out.    Best of luck.
Dr Michael McClure M.D.

Thank you for the question.

Some of the sutures used during breast reduction surgery are longer-lasting;  it sounds like some of these have come to the surface in your case. Once these sutures are  removed  your incision line should go on to heal nicely.

Best wishes.

Breast reduction surgery is a very popular and effective way to remove tissue that may cause symptoms such as pain or discomfort and to contour the shape and position of your breasts. In our practice, we emphasized that there is a significant recovery process after breast reduction surgery. During the surgery, we only use sutures that will dissolve on their own. This process may take anywhere from 6 to 9 months depending on the type of suture that was used. If you continue to have the suture after that time was a suture has broken through the skin, you should return to your plastic surgeon will assess you and determine if the suture can be safely removed.
 

Dissolvable sutures are great and I used them all the time. However, once in a while before the completely dissolve, they can make their way out of the skin and cause the problem that you just mentioned.

The dissolving sutures which we use to close wounds are usually well tolerated, however patients don't come with a "user's manual", advising physicians which sutures to employ. Many physicians prefer to repair breast reduction scars in layers, using clear, colorless sutures, (Monocryl, PDS, etc) which disintegrate slowly, up to 6 months post-op. Occasionally however individual suture knot remnants tent the skin, breaks it and causes a pink, "pimple" like response. This can be corrected, as your physician did, by removing the knot.
More recently, some plastic surgeons have been using an absorbable "barbed" suture, which can also produce this effect with several "pimples" occuring like pearls on a string. This isn't as readily corrected, because it usually means that the barbs are too superficial and thus more likely to "spit". Hope this helps.