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When is Mesh or AlloDerm Necessary in Diastasis Repair?

asked 3 years ago by shaymariep in Grants Pass, OR
Latest answer by John P. Di Saia, MD
Question viewed 4,288 times
Tags: abdomen

I'm 5'2" and 120 lbs. A year ago, I had twins weighing 6lb 7oz and 6lb 14oz. My skin was stretched to the max, which resulted to "twin skin" and severe diastasis recti. I've consulted two cosmetic surgeons. One said I need AlloDerm or mesh, and the other said I don't. In what cases can you say that AlloDerm or mesh is necessary with Tummy Tuck for diastasis repair? Do I really need it at $2000? I need to schedule this for next week; please help.

Picture was taken in a tub, so the separation is more noticeable.

12 answers to When is Mesh or AlloDerm Necessary in Diastasis Repair?

You don't need mesh or Alloderm

If your surgeon undermines up to the xiphoid, he/she should be able to correct the diastasis with sutures alone. Since you are thin, you might be able to see or feel the mesh; Alloderm may be useful in some surgical situations, but not here. With this wide a diastasis, just make sure the extent of undermining of the abdomen is to the xiphoid and rib cage.

G. Gregory Gallico III, MD
Boston Plastic Surgeon

No need for mesh or Alloderm

Since your diastasis is from pregnancy and you do not have a true hernia, it would be very unusual to need a mesh and certainly not Alloderm. Some surgeons might consider it to reinforce the closure but I doubt if that is necessary. If you were to have a failure of repair or a large hernia, it might be considered. You also look like you are not boese and the muscle should be able to be brought back to its original position.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Mesh or Alloderm not usually needed

Your picture shows pretty severe diastasis, but in 13 years I have not needed to use AlloDerm or mesh in a diastasis repair. Mesh comes with its own risks. Make sure you understand the risks and benefits before you proceed. Best Regards.

John P. Di Saia, MD
Orange Plastic Surgeon

Mesh is not my first choice for diastasis repair

It is quite interesting how so many plastic surgeons agree that they would not use mesh. I must say that in 20+ years the only time I have used mesh was on a breast reconstruction for a TRAM flap in the early 90's. I don't think you would need mesh or alloderm in doing a tummy tuck and just repair of the diastasis would give you a very nice result. I use Alloderm or allograft material in breast reconstruction because it has elasticity and stretch which is just the opposite of what you... more

Steven Schuster, MD
Boca Raton Plastic Surgeon

Mesh or AlloDerm not necessary in diastasis repair

Absolutely, NOT. The use of mesh should be a LAST recourse when the muscles (or their fascial lining) are destroyed. I have operated on women such as yourself many times and never had to use a mesh. One, which I believe was much worse than yours, posted her pictures on this website, at http://www.realself.com/review/Full-Tummy-Tuck-w-o-lipo. See for yourself. I would delay and consult with another Plastic surgeon (www.PlasticSurgery.org) Good Luck.

Peter A. Aldea, MD
Memphis Plastic Surgeon

When is Alloderm usage indicated

Hi, Alloderm and Strattice (second generation biologic mesh made by same manufacturer) have a role in complex abdominal hernia reconstruction. Utilization of these products have been shown to result in lower hernia recurrence rates. You do not have a complex abdominal hernia. Diastasis recti, although unsightly, represents midline separation of the rectus abdominus muscles - there is still intact abdominal wall fascia. As a result, treatment is geared toward sewing the muscles back... more

Sam Jejurikar, MD
Dallas Plastic Surgeon

Repairing rectus diastasis

From your history and your photos you definitely do not need Alloderm or mesh. Also you do not need a cosmetic surgeon - you need a Board Certified Plastic Surgeon, preferably one who is also Board Certified in Surgery for the extra experience in surgery of the abdomen.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

Diastasis recti repair doesn't usually require alloderm or mesh

I agree with all the other consultants that your case should be able to be repaired, using your own fascia, providing the loose abdominal skin is raised from the pubis to the rib cage (xiphisternum). Several post-op factors may contribute to failure of the repair of your diastasis recti. These include constipation, coughing, overly strenous activity undertaken too soon. As long as you have adequate time to convalesce, you should have a satisfactory convalescence and a great result! good... more

Lavinia Chong, MD
Orange County Plastic Surgeon

No need for Mesh and definitely not Alloderm

Diastasis is usally repaired directly specially in someone who has lost all their pregnancy weight. If you have a true hernia, then you may require a mesh. Alloderm stretches and you can get recurrent protrusion of your abdomen. Discuss with your surgeon your options again and most likely the only thing required in the repair of your rectus muscle is your own fascia which is the covering of the muscle. Good luck.

Bahram Ghaderi, MD
Chicago Plastic Surgeon

No mesh

Not necessary. All it does is increase the risk of infection and mesh in particular can give you the sensation of having a dinner plate on your belly -- it can be very firm and uncomfortable. Make sure your surgeon is certified by ABPS - the American Board of Plastic Surgery and good luck!

Robert S. Houser, DO
Columbus Plastic Surgeon

Direct repair for diastasis recti

The best way to correct your distasis recti is by direct repair. This can be repaired in most people without a problem. In a few people (those with previous large abdominal hernias and previous surgery with bad tissues) mesh (not alloderm) may be required. But in your case, find someone who feels comfortable tightening your own abdomen with your own tissue. Good Luck!

Robert M. Freund, MD
New York Plastic Surgeon

Usually not needed

You have a severe diastasis (separation of the) recti. I have seen and treated much worse, with nice results. What determines the need would be the condition of the fascia, or strength layer over the muscle. I can't remember in 16 years that I have ever needed to use mesh and absolutely no Alloderm. In doing breast reconstruction where we use the muscle, I would use mesh. However, I like to keep it simple and not use foreign material wherever possible. sek