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My Rectus Diastasis is Wide and Dr. is Concerned the Stitches Won't Hold, Should I be Concerned? (photo)

Plastic surgeon concerned about the stitches holding it together. What are the chances of internal stitches not holding? Is there a way to triple stitch it or something to make sure it stays put? If it does not stay am I responsible for paying for this failed tummy tuck? Is there a way to reinforce it? I have a small umbilical hernia too but the General Surgeon would stitch it vs. using mesh. I might lose my belly button too...assuming he'd create a new one for me right? I had 2 babies csect

Doctor Answers (7)

Diastasis treatment with Mesh Reinforcement

+2

Most likely pregnancies or weight gain has damaged your fascia and now you have a protruding abdomen and an umiblical hernia.  The best repair technique is an abdominoplasty with mesh reinforcement.  A large piece of mesh is sewn from side to side to eliminate reoccurrences.  There have been articles published on abdominoplasty with mesh reinforcement recently in the Plastic and Reconstructive Journal and you are an excellent candidate for this technique.

Best Wishes,

Gary Horndeski, M.D.


Texas Plastic Surgeon
5.0 out of 5 stars 120 reviews

Abdominoplasty with diastasis repair

+2

Many patients present with wide diastases after Caesarean sections and the experienced plastic surgeon is accustomed to dealing with this problem.  I am concerned that you are already characterizing a tummy tuck yet to occur as "failed".  I agree with Dr. Tehrani that I do not involve a general surgeon; most board certified plastic surgeons of my generation are fully trained in general surgery and a hernia is a basic procedure which we are competent to address during the abdominoplasty. 

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 8 reviews

Abdominoplasty and diastasis recti / hernia repair

+2

Thank you for posting appropriate pictures. You do seem to have rectus fascial diastasis as well as an umbilical hernia. Most plastic surgeons with expertise in this area will not find recurrence an issue and will address the umbilical hernia at the same time. In my practice, I involve general surgeons only if there is a complicating incarceration involving bowel. Otherwise a proper plication with permanent sutures as well as a hernia repair without mesh will likely work for you. At times I use the skin to be removed from the abdomen as a reinforcing mesh on the repair if the integrity is in question. Best of luck.

Kevin Tehrani, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 39 reviews

Wide diastasis rectus

+2

Thanks for the great photos, it helps.  You have a significant diastasis, but I believe an experienced plastic surgeon can repair this without a high rate of recurrence.  I reccomend patients like yourself to wear an abdominal binder for one month before surgery to help your abdominal wall to get used to pushing the intestines back inwards. In terms of your hernia, it can be repaired at the same time safely and you are correct your own belly button may be lost if its blood supply is affected by the hernia.  An attempt at a new umbilicus can be tried, but sometimes their appearance can be dissapointingly shallow on someone as thin as you. Good luck.

Vishnu Rumalla, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 68 reviews

Does fascial repair always work?

+2

Some people develop abdominal bulge as in your photo because the rectus muscles have pulled apart, but for many patients, the entire abdominal wall fascia is weak.  If this is the case, simply pulling your muscles together in the center with a row of stitches will not succeed in correcting the problem, and instead the entire abdomnal wall fascia needs to be assessed during surgery to decide which areas need tightening.  It is also true that some people have fascia that is so weak that there is little to stitch, and despite a perfect operation there is less than an ideal result. I think your surgeon is being appropriately cautious in describing a result that may be less than ideal.

Michael Kreidstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 5 reviews

Odds are with you, diastasis repair will hold up

+2

Though your abdomen is very lax, you are not unlike many other patients looking into a tummy tuck. The diastasis repair can be done with a permanent suture in a double layer and we find it to be very durable. The umbilical hernia repair can be tricky, and we prefer to complete the repair without a general surgeon as the circulation to the belly button can be in jeopardy and no one will care as much as a plastic surgeon. Making a new one is second best.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 26 reviews

Repair of Diastasis Recti and Umbilical Hernia Concerns…

+2

Thank you for the question and pictures.

Assuming you have chosen your plastic surgeon carefully ( make sure that he has significant experience and can demonstrate this experience to you via pictures…), the odds of a successful repair of the diastasis recti  are in your  favor.  In other words, recurrence of the diastasis recti should be an unusual complication.  Many plastic surgeons use a “2 layer” repair technique.

Whether or not the umbilical hernia requires a mesh repair ( for a “small umbilical hernia") is debatable in my opinion. Loss of the umbilicus  although possible should be a rare  occurrence.

Obviously, based on the fact that you are asking the question, you have concerns about the information you have received.  On the one hand, your plastic surgeon may be trying to be thorough with the potential risk/complication discussion (informed consent).  On the other hand, if you  have concerns about the abilities/experience level of the plastic surgeon you may benefit from additional in person consultations.

 I hope this helps.

 

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 682 reviews

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.