Do you find suturing of the abdominus rectus muscles during a cesarean section decreases the need for reconstructive surgery?

Question

There is debate amongst obstetricians whether the separated abdominus rectus muscles should be reapproximated and sutured during closure of a cesarean section. As cosmetic surgeons, do you find suturing affects the need for future surgeries to repair hernias, etc or for elective tummy tucks?

John Nguyen, MD, FACS · Answer

Cesarean sections are for delivering babies... really not a time to perform a cosmetic procedure in my opinion.  Secondly, the limited exposure of the csection incision would severely limit the plication.  Good luck
and be safe.John T.
Nguyen, MD, FACS, FICSDouble Board
Certified Plastic Surgeon

Gary Lawton, MD, FACS · Answer

It is really not feasible to plicate the muscles at the time of a C-section in the way they would be at tummy tuck.  First, the uterus is still enlarged so it is not possible togged the muscles tight enough.    Second, the C-section exposure and the tummy tuck exposure are completely different. This is not a good idea.

Don W. Griffin, MD · Answer

I realize that this would seem to be ideal since you are already under anesthesia and just had your baby, but in reality it has never caught on as a procedure. For one, it increases the complication rate for the C-section since you have to undermine the abdominal skin to do the muscle tightening. Also, there is really no way to know how much muscle tightening to perform or how much skin to remove immediately after delivery. It is best to let your tissues shrink up, then have the abdominoplasty.

James A. Hoffman, MD · Answer

The most important thing is a safe delivery and recovery from a C section. The uterus is too large at the time of delivery to tighten the abdominal muscles significantly. A C section incision is too low to allow access to the rectus muscles up past the belly button and it would be unwise to lift the skin to attempt this. It is best to fully recover from childlbirth and plan a Tummy Tuck for when you are finished having children.

David Janssen, MD, FACS · Answer

It would be difficult for plastic surgeons to answer this question.   We certainly see women who have stretched out fascia after childbirth.  This leads to a lower abdominal "pooch" which they don't like.   Gynecologists could sew the fascia but that would require that they elevate the fascia  all the way up to the bellybutton from the low transverse incision and a typically would not want to do that nor  was they get paid for it  by an insurance company.   It would also increase the risks of the cesarean section with possible need for drains and wound problems.  The other half of the problem is that the loose skin that is left   is frequently the major problem rather than the fascia.   In the absence of dealing with the loose skin, patients would likely still be  disappointed in the results.   Almost everyone  needs skin removed.  Not everyone needs their fascia tightened.

Norman G. Morrison, MD, FACS (retired) · Answer

Obstetricians do not
normally suture the rectus abdominis muscles, as their only concern is to
deliver the baby, and closing the abdomen at the soonest possible time. The procedure that is done for the muscles is
coaptation or joining together of the edges. However, if a patient requests
suturing of the muscles, she may discuss it with the obstetrician prior to the
cesarean section. Even when she has it done, there is still no guarantee that
she would not be needing reconstruction surgery later on.

Do you find suturing of the abdominus rectus muscles during a cesarean section decreases the need for reconstructive surgery?

Answers (6)

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