A tummy tuck, or abdominoplasty, removes excess skin and fat while tightening the underlying abdominal wall. This procedure is often sought after pregnancy or significant weight loss to restore a flatter, firmer midsection. The success of the procedure relies heavily on internal sutures, and the thought of these stitches “ripping” causes anxiety during recovery. This article details the function of these internal repairs and helps distinguish between expected healing sensations and potential warning signs. Immediate contact with your surgeon is always necessary if you suspect any complication.
The Function of Internal Sutures in Abdominoplasty
The internal sutures perform a specific task known as fascial plication, often referred to as “muscle repair.” The rectus abdominis muscles, commonly separated after pregnancy or weight fluctuations, are encased in the fascia. The surgeon uses these sutures to pull the stretched fascia back together along the midline, creating a corset-like effect that flattens the abdomen and restores core stability.
This plication is a permanent structural change. While the sutures may be permanent or long-acting absorbable material, the surrounding tissues must heal and form a strong internal scar to maintain the repair. Long-acting absorbable sutures, such as PDS, can take several months to dissolve entirely. Their integrity is most crucial during the first six to eight weeks of recovery.
Distinguishing Normal Post-Op Sensations
Immediately following the procedure, patients experience normal sensations often mistaken for complications. An extreme feeling of tightness or rigidity across the abdomen is expected, resulting from the fascial plication that physically shortens the abdominal wall. This sensation often forces patients to walk slightly bent over for the first one to two weeks, as standing straight places tension on the healing tissues.
Swelling (edema) is a persistent and common side effect that can last for several weeks or months, as it is the body’s natural response to surgical trauma. Bruising and a feeling of numbness or altered sensation in the lower abdomen are normal because sensory nerves have been disrupted. This altered feeling can present as tingling, intermittent shooting pain, or a general lack of feeling that gradually resolves over six to nine months.
The discomfort experienced is typically a dull, generalized aching that is manageable with prescribed pain medication and improves consistently over time. Mild pain and stiffness that lessen with rest are expected consequences of the muscle repair. The feeling of tightness and mild pain are signs the repair is in place, not signs of failure.
Specific Warning Signs of Suture Dehiscence
Suture dehiscence, or the tearing of the internal stitches, presents with symptoms that differ from normal post-operative discomfort. The most concerning sign is a sudden, sharp, or tearing pain that occurs immediately after a specific straining activity, such as a cough, a sneeze, or attempting to lift something heavy. This pain is often described as feeling like something has suddenly “given way” inside the abdomen and is typically debilitating, not responding to regular pain medication.
A sudden, visible change in abdominal contour is the most definitive physical sign of internal suture failure. This presents as a new, localized protrusion or bulging along the midline of the abdomen where the plication was performed. This bulge is essentially a new hernia, where underlying tissue or organs push through the weakened fascial wall. The protrusion may be more noticeable when sitting up or standing and can temporarily reduce when lying flat.
Systemic signs like a fever over 101°F, chills, or rapidly spreading redness and warmth around the incision site, when combined with severe pain, require urgent medical attention. An unusual increase in fluid collection, such as a new or rapidly enlarging seroma, can also accompany a structural failure.
Immediate Actions and Medical Consultation
If you experience a sudden, sharp pain accompanied by a noticeable bulge in your abdomen, stop all activity immediately. Contact your plastic surgeon’s office at once, utilizing their after-hours or emergency contact instructions if necessary. Do not wait for a regularly scheduled appointment to discuss these symptoms.
Your surgeon is the only person qualified to assess the integrity of the internal repair and determine the necessary course of action. If symptoms include signs of severe systemic distress, such as uncontrolled bleeding, shock, or a high, persistent fever, proceed directly to the nearest emergency room. Adhering strictly to all post-operative restrictions, particularly concerning lifting and strenuous activity, is the best way to prevent future strain on the healing tissues.