Prominent, Rock Hard Belly - Diastasis Recti? (Male)

Thank you for your question and photographs, and I can see your area of concern. Based on his ultrasound findings, your husband has a separation of his "six-pack" muscles from his belly button up to his breast bone. In males this is most commonly caused by weight gain inside of the stomach, around his internal organs.  It is possible to fix this separation, but it will not significantly change is outer appearance.  I would recommend he pursue a healthy diet and exercise regimen, perhaps supported by a nutritionalist and trainer who can help him lose weight.  This weight loss will help reduce the protuberant aspect of his stomach, but may leave him with a bit of skin excess. Should this occur, a male tummy tuck can be performed to repair is separated muscles and remove any skin excess in a single setting. Hope that this helps. 

Hello, thank you for your question about your husband’s abdominal wall. Plastic surgeons are presented this question almost on a daily basis. Your husband has excess visceral fat. Visceral fat is fat around his organs. His visceral fat is so extreme that it is pushing out his rectus abdominis muscle. His rectus abdominis muscle is not the problem; the problem is the fat behind the muscle. This is why he may not appear to have much fat under the skin, but has a lot of fat under the muscle. Liposuction and or a tummy tuck will not improve his appearance much. He needs to lose weight. The best treatment for his condition is diet and exercise. He should consider a ketogenic diet or caloric restriction. He may also want to consider newer weight-loss medications, such as GLP-1. If you have any more questions regarding tummy tucks, abdominoplasty, or abdominal liposuction, contact an experienced plastic surgeon. Since the tummy tuck surgery is a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience in performing tummy tucks.  Do your research.   If you cannot find an experienced tummy tuck plastic surgeon in your neighborhood, consider traveling out of state.  Sincerely, Dr. Katzen, MD, MBA, FACS, FICS. ( Plastic Surgeon, President of the American Society of Bariatric Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and  member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

While diastasis recti may contribute to some of this protrusion, it is most likely caused by visceral fat. This fat is far below the skin and surrounds the organs. I would suggest following a healthy exercise and diet plan to help reduce these fat stores, then consider surgery if desired to repair the muscle separation. 

It looks like your abdomen is distended because you are overweight.  The most important thing you can do for yourself is lose 15-20 lbs through diet and exercise.  You may not even need surgery if you do that.  Your skin looks great and should tighten up.

There is an excess of intraabdominal fat.  This cannot be removed by suction and abdominoplasty would make very minimal improvement with significant risk of complication.  Weight loss is the sensible way to deal with this specific problem.

Men carry their fat on the inside of the abdominal cavity more than on the outside, which is where women carry more fat.  As a result, a man can have a big round tummy WITH VISIBLE ABS on some occasions in spite of an excess of body and abdominal fat.  A tummy tuck or liposuction will not fix this problem, since the fat must be lost in order to shrink the abdomen.  As a result, diet is the key to improvement rather than surgery.  Once the weight is lost, it's possible that skin removal might be needed, but often times there's not much loose skin, depending on how long the person was overweight and how extreme the weight gain/loss was. 

Thank you for the question and pictures.

I think it would be in your husband's best interest to be seen by a well experienced  board certified plastic surgeon. Simple physical examination will be enough to determine if your husband is a good candidate for any type of surgery. For example, if the “pinch test” demonstrates significant subcutaneous adipose tissue, he may be a good candidate for liposuction surgery. If, on the other hand, he has significant abdominal wall laxity (muscle laxity) he may benefit from tummy tuck surgery. Sometimes, especially with men, the adipose tissue may be intra-abdominal and he would most benefit from diet and exercise.

I hope this helps.

Unfortunately in men a rock hard abdomen is more often caused by fat inside the abdomen pushing out than  from 1000 sit ups.  Men and women put fat in different places.  Women tend to put their excess on hips and thighs, or the external fat layer of the abdomen.  Men place it in the love handles and inside the abdomen around the organs.  His muscle separation is only about 3/4 of an inch and wouldn't tighten noticeably

It is likely that your husband's fat is inside the abdominal cavity, as is common in men, and not just under the skin. If that is the case, his best option is to loose weight with a combination of diet and exercise. A tummy tuck is unlikely to make a significant difference.

Diet, exercise, and weight loss are the keys to helping your husband feel better about himself. I would not recommend surgery. Best of luck!