Diastasis Recti Repair: Do You Really Need a Tummy Tuck?

Authored By Lisa Cassileth MD, FACS

woman sitting

One of the most common misconceptions I hear from patients is that they must get a tummy tuck to repair abdominal muscle separation. This is not true!

What is Diastasis Recti? 

First of all, what exactly is Diastasis Recti? Also known by the medical term rectus diastasis or diastasis rectus abdominis, it is basically when your “six-pack,” the rectus abdominis muscles, split down the middle. This causes a belly that sticks out, especially at the end of the day and after big meals, and typically does not respond to diet or abdominal exercises. 

What Causes Diastasis Recti?

Abdominal separation is most common after pregnancy. Pregnancy puts pressure on the abdominal wall from the inside, and as a result, the muscles may spread down the middle. The more children you have, the more likely you will experience rectus diastasis since the abdominal muscles will weaken over time. That said, the condition isn’t exclusive to postpartum women. It is also seen in middle-aged, typically overweight men, weightlifters, and women who have gained weight and lost it again. Yo-yo dieters are often prone to it as well. Aside from the aesthetic downside of a stomach bulge, you may experience uncomfortable symptoms such as lower back pain and weakness of your core abdominal muscles. While rectus diastasis is rarely a serious medical issue, it’s uncomfortable to still have a baby belly. Core weakness, poor posture, and back pain do take their toll over time.

Treatment for Diastasis Recti

Now let’s discuss treatment. A rectus diastasis does NOT require a tummy tuck to be repaired. I frequently repair the rectus diastasis through old C-section scars as well as through belly button incisions. I have heard of other plastic surgeons fixing them through the C-section incision (therefore, ensuring the patient doesn’t have additional scarring), but as far as I know, I’m the only one who has done the “umbilicus” incision. Both the C-section and the belly button incision are ideal since the scar stays small and the recovery is much easier than a full abdominoplasty. Not everyone has a C-section scar, of course, which is why the belly button incision can work better for some people.

I’ve been asked, why doesn’t everyone repair a rectus diastasis this way? I think that plastic surgeons were all taught to do these big abdominoplasty incisions, and it’s so easy to see the diastasis through a big incision than through a much smaller hole. As my patients asked me to go smaller and smaller over the years, I realized that it is not just “do-able” to do the surgery through the smaller incisions; it’s actually preferable in some cases. If you don’t need a skin excision, then you’re better off without it. It simply adds scar, risk, and recovery time that you don’t need. And surgically, it’s easier than you would think as the belly button is right in the middle of the abdomen and the distance to the repair is short.

How Do You Fix  Diastasis Recti Without A Tummy Tuck?

The surgery is done by first making the incision and using the access to “create a plane” between your fat and muscles. That way, the top of the muscles, and the fascia that covers it, can be easily visualized. The plane goes all the way up to the very bottom of the sternum, called the xiphoid process, and all the way down to the pubis bone, at the very bottom of the abdomen. After the whole area can be visualized, the muscles are marked. The “medial edge” of the muscles, which is supposed to be midline, will be split, and the maximum point of the split is usually just under the belly button, right in the middle. Using a special, long-looped suture, the repair is done in one long, strong running repair. Starting at the top, getting wider at the middle, and then tapering back to a point, the full diastasis is brought back to the midline. The central area receives a “double repair” for some patients to ensure a solid surgical repair compensates for the natural higher tension. Then, the patient is seated upright to make sure we “see” all the extra skin and the appearance of the abdomen. As you may have figured out, abdomens always look better lying down, and we need to see it at its worst! With the patient upright, additional tightening is done as necessary, and skin can be undermined laterally to allow the skin to shift to the full abdomen and lie smoothly. 

What About Recovery?

A drain is then placed that stays in for three to four days, and the skin is then closed with small sutures. The patient wears a compression garment to keep the abdomen tight and supported. After one month, heavy-lifting and exercise can be resumed.

So Who is a Good Candidate for Diastasis Recti Repair? 

These small incisions are great, but they don’t remove any skin – they only fix the muscle. This helps me determine who is a good candidate. A good candidate is someone who has stretched-out muscles but not a lot of stretched-out skin. That means that when you get up in the morning, and your stomach is flat, and you suck in all that extra size, that your skin does not hang or double over. The perfect patient looks great in the morning and then looks more and more “pregnant” or stretched-out throughout the day.

Remember, if you have a lot of loose skin or a very wide diastasis, and then surgically I “cinch” your waist back together, all that skin has to fit a much smaller version of you! If your skin is hanging or loose, you may need some tuck (skin removal) on top of the diastasis repair, requiring a larger abdominal incision. A full abdominoplasty is for excessive skin, and the mini-abdominoplasty is when the extra skin is only present on the lower part of the abdomen, below the belly button.

Get Treatment for Your Separated Abs

The most important takeaway is to remember that you do have the option only to fix the muscle. You don’t need to remove skin or make extensive incisions unless you choose to do so. Never let anyone say that you have to have a tummy tuck when you don’t really need it! Contact us to schedule a consultation and learn more about which treatment may be right for you. 

Cassileth Plastic Surgery & Skin Care

Contact Cassileth Plastic Surgery to learn more about anything you see in our blog. Send a message online to arrange a consultation, or call (310) 278-8200.

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