What is the Best Technique to Ensure Diastasis Will Stay Repaired?
- Asked by Lisa in CA in Thousand Oaks, CA
- 2 years ago
Had full tummy tuck with repair to herniated belly button and diastasis recti repair. 7 1/2 weeks post op today. Noticed upper abdominal bulge 1 1/2 weeks ago, saw PS and was told I had loosened the stitches in that area. Revised tummy tuck suggested. The only stress I put on my stomach was coughing from a cold. Could I have thinner tissue than the average person and is there a special surgical technique that can be used to prevent area from bulging after revised tummy tuck?
Separation of Diastasis Repair?
Thank you for the question.
Sometimes despite best efforts and techniques separation of diastasis repair can occur.
The best way to ensure the diastasis recti stays repaired is to pick a board-certified plastic surgeon with significant experience with the procedure. Personally, I use a 2 layered permanent suture repair, with every attempt to find the right balance between sufficient typing of the muscle repair ( without over tightening).
Recurrence of upper abdominal bulge following tummy tuck
It would seem uncommon for you to have a bulge starting 6 weeks post op that was flat at 5 weeks. Without the advantage of examining you it is difficult to speculate why. If re operation is considered, I might suggest waiting for 6 months to allow your soft tissues to soften and see what develops in the rest of your fascial plication. When sutures pull through it may be on the basis on thin soft tissues or sutures being pulled too tight. The type of suture is probably less important. I saw an interesting presentation at the QMP meeting from last October outlining some peculiar anatomic variations which can predispose to recurrent fascial laxity following standard pliction procedures. Might suggest your PS look into this topic.
Looseness After Diastasis Repair
The looseness of the upper tummy is either due to the sutures breaking or the fact that it was not tighten enough in the first place. There are many different ways to tighten the tummy. Some docs use absorbable sutures while others use permanent ones. Some do a single layer repair while others will do two or three layers. Finally it is easier to tighten the lower part so that as the lower area is tightened first it puts more pressure on the upper area which makes it more difficult to get really tight. Usually it's not a problem but perhaps that helps to explain your case.
It is certainly possible that you inadvertantly ruptured supporting sutures that held your muscle repair together, but it is unusual to do that, even with coughing. There is no special suture technique to keep a muscle plication repair intact except for using multiple individual sutures in addition to any 'running' type sutures.
I really wonder what is your bulge truely caused by. Much more common than suture rupture is a formation of fluid under the skin called a seroma. Seromas can be treated in the office by aspirating the fluid (serum), and don't need a second operation. I would double check with your surgeon to make sure that it is not a seroma that can be treated easily and immediately!
Best of Luck!
Bulging post tummy tuck.
I can not say without an exam if you did any harm. It does happen however. My suggestion is to wear a surgical garment for another 6 weeks or so, and be careful. hopefully it stabilizes and you do not need the procedure. Stay in touch with your surgeon as they are the best ones to evaluate how much of an issue it will be.
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