When Stomach Muscles Are Stitched Together, What is Used, is It Strong and Holds Up Long?

The rectus muscles, that you see as a "six-pack" in body builders, typically get pushed apart during pregnancy (called a diastasis.) Because the direction of contraction of the muscles is up and down, not sideways, they cannot be pulled together with exercise which is why they are repaired with a tummy tuck. This repair does not involve cutting the muscles, or even putting the stiches into the muscle. They are encased in a tough lining called fascia, which holds the sutures. After the repair is done the body has to heal it just like with a hernia repair. So in the long-term, it is your own tissue that supports the repair regardless of the sutures. However, we use permanent suture material just to make sure that it holds up long enough for strong healing.

It is more of a "realignment" of the muscles.  They are not cut.  They are not even exposed.  The sheath around the rectus muscles is sewn together in the midline, correcting the bowing of these muscles that occurs after pregnancy or weight gain.  The sutures need to hold the tissues together long enough for them to scar together.  Then the sutures are not really necessary.  Many surgeons (myself included) use permanent sutures out of an abundance of caution, to make sure that the muscles are held together long enough for this bond to take place (two months should be adequate).  However, absorbable sutures probably stay around long enough too.  The muscle repair is one of the gratifying benefits of a tummy tuck.

Many people use the term "muscle tightening" when referring to a full tummy tuck / abdominoplasty.  What is actually happening is a rectus diastasis repair.  This means that the fascia between the muscles is sewn together.  Usually a permanent sutures such as Nylon is used.  In my patients I do two to three layers of sutures to create a very strong plication (attachment).  I hope this answer is helpful.

 

Good Luck.

Preference for suture material varies depending on the surgeon- some using absorbable sutures and others permanent sutures. Various suturing techniques are also employed, some using continuous sutures while others using separate or interrupted suture. As long as the grade of suture material is thick enough the technique may not matter, although my personal preference is interrupted permanent suture for the most secure closure. Whatever technique is utilized it is most important that during the post operative period heavy lifting or significant exercise that could potentially disrupt the repair be avoided for 6 to 8 weeks.

In a tummy tuck, the tummy muscles are stitched together with strong, permanent suture.  The muscles themselves are left alone, and the fasica, or outer covering of the tummy muscles, are where the sutures are placed to tighten the stomach muscles.

 

Typically the suture is permanent, meaning that the suture material won't dissolve.  Also, 2 or even 3 sutures are used, so that even if 1 suture fails, the other ones will hold the stomach muscles together.  The material and the number of sutures should give you a lifetime ot tightness and support.

Yes it does last. But, everyone does this part a little different . I will place two rows of sutures for extra support. But one row is just fine for most. The trick to longevity with this is giving it time to heal and strengthen. Crunches within a month of  the procedure would be a bad idea. Start slow and get guidance from your BC plastic surgeon. Good Luck.

Re: "wondering... when the stomach muscles are sewn together, are they cut then sewn so that they grow together, or is the muscle dependent on the material used to stitch it together? How durable is the "product" that is used?"

Great question.

Extreme weight gain and pregnancy are associated with separation of the Six Pack muscles and out stretching of the OTHER abdominal wall muscles. As a result, the most important factor in a Tummy Tuck is the decreasing of abdominal volume by the "taking in" of the muscles. The procedure is called "PLICATION" and involved a variable tension stitching of the six pack muscle lining (fascia) together without cutting the muscles. E

Every surgeon does this differently and has his reasons for doing it a certain way based on his experience. Some use interrupted stitches, others use a continuous running stitch. Some use permanent sutures (Nylon, Prolene etc) others use long-term dissolving (such as PDS). Some surgeons use a one layer plication repair while others use two or more layers.

Personally, I like to create a narrow waist with a TOTALLY flat tummy and I use a 2 layer muscle repair; deeper layer - permanent, individual stitches to guard against loss of repair should one area break, superficial muscle repair with a permanent, continuous double stranded prolene suture.

The stitches are not a long-term replacement for good healing and are merely a splinting aid which holds the muscles together until the body's scar tissue glues everything together. As a result, you should not diet by cutting your protein intake in the months after surgery - you want to help your body heal properly.

Good Luck.

Dr. Peter A Aldea

Suture is used to stitch the muscles and it is usually permanent suture.  It will not dissolve and usually is strong and will allow a scar to form to hold the muscles tight.  It is important, however, to modify your activity for 6-8 weeks to allow adequate healing for strength.  I hope this info helps.

The muscle plication which is a part of most full tummy tucks does not involve cutting the muscle.  The muscle is imbricated or sutured in such a way that it is brught together and the soft tissue between the muscle edges  is directly towaard the abdomen.  The type of suture material is the surgeon's choice.  I use a permanent nylon suture which does not dissolve.

A tummy tuck helps 3 problem areas of the abdomen. First is removal and tightening of the excess skin. Usually all the skin from just above the belly button down to the pubic bone is cut away.  Second is the removal and/or thinning of the fatty layer.  All the fatty tissue beneath the removed skin mentioned above is also cut away; then the remaining tissue, including fat in the upper abdomen is stretched downward, ultimately making the fatty layer thinner. Finally, the paired rectus muscles which extend the length from the bottom of the breast bone to the top of the pubic bone is tightened. There are various techniques, but usually an "imbrication" stitch is placed in the "fascia", or strong, thin covering of the muscle, such that when the ends of the stitch are tied, the edges of the separated muscles are brought closer together. No cutting of the muscles is performed.  Personally, I place a "figure of 8" stitch made of a strong synthetic non absorbable suture that feels similar to a heavy duty cotton or polyester thread you use for sewing.  It comes in different sizes, and a size that is strong enough to hold, but not so big to cause a foreign body tissue reaction is generally selected.  Every surgeon has their own particular preference. Typically, those stitches are never felt below the skin. And eventually, scar tissue bonds the "imbricated" tissue, so that even if a stitch would break, the scar tissue holds the fascia/muscles together.

Some women have very little "diastasis" (separation) of their rectus muscles, and don't need significant muscle tightening.  But anyone that has had at least one pregnancy will have some separation of the muscles and the only thing that brings them closer together is surgery....all the abdominal exercises in the world will NOT correct diastasis. I hope this has more than answered your question!