Mesh Support for Recurrent Diastasis?
- Asked by tlc14_2002 in Canada
- 4 years ago
Has anyone here worked on a recurrent diastasis using mesh (what kind recommended?) to support the re-plication of that diastasis? If not mesh, what method did you use that worked? I am on my second recurrent diastasis (fell down stairs at six weeks) and am looking for any way to make sure after my third diastasis repair that I never have to deal with this again (I haven't gained any weight). My plastic surgeon uses 3 layers and used thicker sutures for the diastasis the 2nd time.
Mesh support for repeated tummy muscle separation (diastasis)?
I tend to agree somewhat with all of my colleagues, especially Drs. Di Saia, Zwiren and Rand.
Without a Pre-surgical picture, it is impossible to asses just how loose your abdominal wall really was and how much of a diastasis you had. The best way to document this photographically is with a SIDE PICTURE of the patient bent over at the pelvis WITH THE TUMMY COMPLETELY RELAXED (very hard for most women) in the diving position (as if diving off the side of a pool). If you have a large diastasis, you will have a positive hammock sign.
Assuming your muscle plication was done correctly and enough time passed to allow scar tissue to glue and solder everything together, it would take an organ shattering blow to disrupt the diastasis repair. This is much more act to happen if it occurred in the early post-operative period before adherence took place and the surgeon used a running (instead of interrupted) suture - which if one loops bursts - the entire repair becomes undone. Such a tear / rip results in progressive weakening of the fascial lining of the muscle making subsequent repairs less secure.
In such cases, we would have to reluctantly use meshes with Biological meshes (Alloderm, Strattice etc) leading the list (and being VERY expensive).
Personally, I would wait AT LEAST six months if not longer for the swelling and inflammation to subside. At that time you could re-asses the situation and decide if to go back in or accept a result which MAY be better than it is today.
Correcting a recurrent diastasis with mesh
Tummy tucks are a very popular and effective technique to contour the abdomen. During this surgery, we typically perform a muscle repair to bring the separate muscles together. One of the possible complications after a tummy tuck is a loosening of this muscle repair. If this has occurred, it may be possible to repair this through additional suturing techniques. It is not common to try to repair this loosening with mesh. Keep in mind that we always want to avoid adding artificial materials to your body unless we absolutely have to. Mesh is typically used to repair the abdominal wall or musculature that has a defect, not a abdominal wall that is just weak.
To learn more about tummy tucks, see photos, and help you decide which one is best for you, please visit us at the link below:
Web reference: http://www.miamiaesthetic.com/abdominoplasty_photos.htm
Recurrent rectus diastasis for a third time
Looking at your pictures, I am impressed that your scar doesn't look very well crafted. No offense intended to your doctor, but I hope the internal work was done better that what I am seeing externally. Additionally, your result before the fall looked unrealistically tight as if you were sucking in your abdomen. It is possible that you were over tightened and the result just equilibrated and stretched out regardless of the fall. In other words, regardless of another repair and regardless of mesh or Alloderm, you might just be destined to look like this in the end.
Web reference: http://www.randcosmeticsurgery.com
Alloderm may be a better choice with recurrent abdominal weakness
Each time you have a recurrence the probability of a recurrent widening or loss of fascial support increases. It is possible that you may benefit from a reconstruction of your abdomen using a material such as alloderm. The use of this material is derived from human skin, may help provide added support and may avoid some of the complcations associated with the use a traditional surgical mesh.
Many mesh materials
There are many different mesh materials and I understand your confusion. Although initially, it was thought that stiffer materials would provide the strongest support, there has been a change in the thought process. Now, there are some mesh materials with a slightly elastic component. However, these are relatively new and the long term effects are still not completely understood.
Mesh can be a problem, be careful
While mesh can be used to support a repair, it is not advisable in my opinion. The risk of infection and long term pain are not large, but they exist and I have seen a few patients like this over the years. If you get into this situation, the mesh is very hard to remove and the pain may be permanent.
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.