How High Up Torso Does Diastasis Repair and Tummy Tuck Go?
- Asked by swimchick in San Francisco CA
- 2 years ago
Before my full TT, my ps told me I had a diastasis of 3 fingers apart. After sx, he told me I was sew from my breast bone to my pubic bone, however I only feel the sutures internally from right above my new belly button to right below my TT incision line. My upper torso looks the same as pre-sx w/squishy & some baggy skin above my BB. Should my MR been sewn up higher and should I still have loose skin left over? My ps tells me TT's are a lower abdominal procedure. I'm 5'4", 115 lbs. Need advice.
Diastasis repair during a Tummy Tuck is the surgeons discretion
Tightening the fascia that surrounds the rectus muscles is commonly performed as part of a standard tummy tuck. Some patients have an easily felt separation between the mid-line muscles known as a diastasis, while others just have an overall laxity. Tightening this layer to restore a more flat abdominal profile usually involves a tapered tightening that extends from the lower part of your breast bone to the pubic bone.
In some cases, the tightening of the deep layer can exaggerate the looseness horizontally of the skin. Having a clear understanding of the shape improvements and effect on the skin is important to discuss before surgery. Tightening the upper abdominal skin after surgery is difficult and often not worth the additional scarring required. Allow yourself to heal completely (more than 6 months) before evaluating your result to closely.
How High Up Torso Does Diastasis Repair and Tummy Tuck Go?
When repairing a diastasis recti, we would usually tighten the abdominal wall fascia from near the xiphoid process at the base of the "breast bone" in the upper tummy to the pubic bone in the lower tummy. This allows us to tighten from a fixed point to a fixed point...otherwise, there is the risk of tightening one area and bulging out the untightened area, as would happen when pushing in on one part of a balloon and having the other part bulge out. That being said, the area of the abdominal wall that is usually the loosest (ie: the most fascial stretching, the widest separation of the muscles or diastasis) after pregnancies is in the mid to lower tummy. Also, sometimes, despite a thorough tightening of the upper tummy fascia, there are cases when it does not seem to respond as well as the lower tummy in terms of retaining that correction. In regards to remaining loose skin above the belly button, this can result from not tightening the skin enough before choosing the placement of the new belly button hole, BUT, sometimes, no matter how tight the tummy is pulled, some patients' skin will relax to a greater degree than desired or anticipated. This can sometimes result in some recurring mild laxity above the belly button.
Diastasis Repair with Tummy Tuck - How high does it go?
The repair will usually go very close to the xiphoid process of the sternum which is the bottom of your breastbone. I have found this area to usually be a little bit more resistant to repair. It just seems that the lower abdomen can be tightened a little easier. In addition the lower abdominal skin is usually tighter as well since the lower abdominal skin gets stretched more during the procedure. These two occurences could lead to what you're seeing. However most of the intra-abdominal fat is up in the upper half of the abdomen and might be pushing this portion of your abdomen more. Your surgeon should be able to explain the findings in a way you can understand. It is certainly possible that these findings are just your normal underlying anatomy as well. Best of Luck Dr Harrell
How high does a tummy tuck go?
Most plastic surgeons repair the diastasis from the lower end of the rib cage to the pubic bone.
I always advise patients preop that they will see somewhat less improvement over the upper abdomen compared to the lower. This is mainly due to the fact that the flap, or apron, is being pulled downward from below. As we get higher on the abdomen the effect of the pull decreases. If it did not, then your breasts would be pulled down along with your tummy.
I usually do a small amount of liposuction over the upper abdomen at the end of the procedure. This tends to flatten the area enough to avoid postop bulging. However, the skin in this area may still not be as tight as you would have wished.
Remember: a tummy tuck is surgery, not magic!
How high up does muscle repair go in tummy tuck?
It may be that your muscle repair was up to your breast bone, but you can still have loose skin in your upper abdomen. A standard abdominoplasty does not address the upper abdomen very well as it focuses on tightening the skin in the lower abdomen where the laxity is usually worst.
In order to address upper abdominal laxity specifically, you would be looking at a reverse abdominoplasty. However this is another relatively major procedure and will leave you with scars in your upper abdomen, just below your breast. You need to leave at least 6-12 months before considering this procedure.
Abdominal plication is important in TT surgery
Tightening and flattening the abdominal wall with plication sutures is probably the most important part of a TT procedure- it recreates a feminine and youthful form in a way that liposuction or simple skin excision cannot achieve. I plicate the abdomen from the xyphoid to the pubic bone level. Partial plication will create a 'partial' result, and who wants that ?
Web reference: http://www.seattleface.com/html/tummy_tuck.php
When the abdominal muscles are "sewn" together, they are done so from the upper abdominal area. If they are far apart (such as you have described), then it should be from the sternum to the pubic area. Close approximation avoids the bulge that can occur in this area if the muscles are not approximated. Another possibility is that you may fat in this area and that will require liposuction to eliminate. Without a photo, or an examination, I can not say if this is so.
How high to repair a diastasis
The true answer is: however high and low it needs to be. In other words, the extent of the repair is decided upon inside the operating room after the area is exposed and the condition of the tissues. What you feel has been repaired or not is may or may not reflect what really was repaired. I would discuss your observations frankly with your plastic surgeon and determine how much these "problem areas" will resolve over time.
Muscle repair length
A TT typically will have varying amounts of muscle repair along the torso where it is tightened the most at the waist so there's no ribs or pelvic bones limiting the tightening and thus reducing the waist as much as possible. The upper abdomen can be stubborn sometimes and you may need liposuction but only on exam would one be able to tell because this area is tough to examine.
Web reference: http://www.doctormeade.com
Muscle Sewing In A Tummy Tuck Usually Runs From Rib Cage Down To Pubic Bone
The purpose of sewing the rectus muscles (technically the fascia of the muscles) is to bring them closer together to help correct one component of the abdominal bulging problem. (the skin and the fat are the other two) This is usually done from just under the rib cage (xiphoid process) the whole way down to the just above the pubic bone. But it is up to the plastic surgeon's discretion as to whether it is beneficial to cover this entire vertical length or not. More pain after surgery comes from more muscle sewing so there is no reason to do more than is absolutely necessary. Not every patient needs the entire muscle length brought together. It is extremely common to see a differential amount of abdominal improvement between above and below the belly button. The best and most flat result is seen between the belly button and the pubis because this is where the skin and fat is completely removed. Between the rib cage and the belly button, there still may be some amount of bulging as this skin has just been pulled down and stretched but not removed. That is likely the reason you have some bulge remaining in this area, it is not due to muscle protrusion. This can be improved later with some liposuction to thin out the tissue thickness in this area.
Web reference: http://www.eppleytummytuck.com/
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.