Why does my stomach look flatter in the morning and it bulges out throughout the day? (Photo)

Question

36 have 3 children. Peo often asked if I am preg. I went to a consu. and I was told that I needed a TT because I have DR. She didn't touch me or x-rays so how would she know I have that?I have no scars or stretch mark so I really didn't want huge scar from hip to hip. Do you think she told me this because the tummy tuck might be easier for her to do? Is there anything else I can do to flatten my stomach? And if I do have a muscle separation why do I look so flat at times like in the mornings?

Christian Subbio, MD · Answer

Somethings need to be examined in person for diagnosis, but it seems from your pictures that you do indeed have a diastases.  The only way to treat this with an excellent result is to tighten the muscles via a tummy tuck.  If performed correctly, the vast majority of patients consider the scar fantastic trade-off for the dramatic improvement in contour.  The scar fades substantially with time, and you are left only with the beautiful result.Best of luck!
Dr. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  Throughout the day, your muscles may be undergoing fatigue and this may make the bulging appear worse.  If this is the case, then you do have a diastasis.  Based on your
photograph, you are a great candidate for a tummy tuck with liposuction.  This can be done through a low and short
incision, all completely below the bikini line. 
The belly button can be designed to look natural and have no scars on
the exterior.   Your muscles can also be
plicated resulting in a flat abdomen. 
Make sure you specifically look at before and after pictures of
real patients who have had this surgery performed by your surgeon and evaluate
their results.  The most important aspect is to find a surgeon you are
comfortable with. I recommend that you seek consultation with a qualified
board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

John Paul Tutela, MD · Answer

Thanks for reaching out.  He doesn't fact look like you have diastases recti. The reason why it is flatter in the morning then in the afternoon is because after the day has gone by and the pressure from the inside of your stomach mounts all day long it continues to stretch.  tell me tuck would so these muscles together and make them flat it from the inside and then skin excision can flatten the skin on the outside.  I hope this helps :)

Richard A. D’Amico, MD, FACS · Answer

Thank you for this interesting question.  
  
During pregnancy the right side and the left side of the abdominal muscles must separate to accommodate the growing fetus.  The muscles of the left and right side never cross the vertical midline and this is what allows a woman’s abdomen to expand to accommodate the baby.
  
After pregnancy most women’s muscles never get back to their original touching position, and that leaves a vertically oriented space down the middle of the abdomen called a diastasis recti.  When it’s really bad even abdominal wall exercise does little or no good.
  
The diastasis will always look better in the morning because during the night the internal organs in the abdomen settle back into the abdomen.  As you assume a vertical position and go about your day, the organs then start to sit forward against the muscle wall.  This is made more obvious when you eat and put food and air in your intestines.  
  
Given this situation, there is little or nothing else you can do short of an abdominoplasty or tummy tuck to flatten your stomach.  Of course, all of this should be confirmed by a consultation which should include both a thorough history and a thorough physical examination of your abdominal wall. 
Lastly, don’t be afraid of the scar.  They usually mature quite well and can be hidden under very skimpy undergarments in most cases. 
Finally, repairing the muscle wall integrity will help your back to stand up to the ravages of time and aging, and make your abdominal work-outs much more productive. 
  
Good Luck!

Kenneth R. Francis, MD, FACS · Answer

Dear proudof3,After 3 full term pregnancies it is very common to have a stretching, or diastasis of the abdominal muscles.  During a tummy tuck operation those muscles are stitched back to their pre-stretched position.  The reason for your abdominal contour changing through the day is that the internal organs rest back into your abdominal cavity while you are sleeping.  When you are up and about your organs push out more to the front and create the bulging.  Abdominoplasty surgery is what you need, but you might be able to improve the bulging with some abdominal muscle strengthening and exercise.  Good luck!

Robert L. Kraft, MD, FACS · Answer

Everyone looks better in the morning before you put food and drink into your stomach.  In terms of diastasis, it is obvious from the photos. This is an issue we deal with daily so please give the surgeon credit for some diagnostic skills.  Btw, x-rays are of absolutely no use in this regard.  The absence of stretch marks externally does not mean that your internal musculature is intact. To the extent that you feel that the plastic surgeon you consulted did not spend enough time with you in consultation, see another with whom you may be more comfortable.

Steven Wallach, MD · Answer

It looks flat in the morning because you are rested and do not have any food in your stomach.  If you have a diastasis, this is palpable on exam and you do not need other studies to confirm that.

George C. Peck, Jr, MD · Answer

Based on your pictures alone, you appear to have a rectus diastasis, a separation and divergence of the abdominal musculature. In the morning, after fasting for 6-8 hours during sleep, your abdomen is flatter. By the end of the day, the abdomen is more distended for two reasons: #1 - you probably have eaten one - three meals which increases the volume of solid and gas in the intestines and #2 - you are most likely on your feet walking, standing or sitting, which allows the abdominal contents to move forward. Without strong support of rectus muscles, together in the midline, the abdomen will look protuberant and distended. A tummy tuck (abdominoplasty) not only will remove excess abdominal skin and fat, it will most importantly tighten the rectus muscles to support your abdomen. A consultation with history and physical examination is necessary to give you the best medical advice and to discuss all of your options. If you are considering to have more children, you should wait until finishing childbearing. Best wishes!

Tania Medina de Garcia, MD · Answer

Hello dear!Thanks for the question and provided photos as well.I agree with the doctor's opinion, that you need a tummy tuck. It's clearly that the abdominal muscles are open. And about the difference between morning and afternoon it's normal, because in the morning all the muscles and organs are relaxed because of the night.I think you are a good candidate for a tummy tuck and you'll have a very good results.I recommend you to make an appointment with a board certified plastic surgeon for a good evaluation and to talk about your concerns and goals.Good luck :)

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