Diastisis recti or hernia? (photo)

The best way to determine the difference between diastasis recti and true hernia is on physical exam, but the photo you have provided and your history of back to back pregnancies supports a diagnosis of a typical diastasis, or separation of the abdominal wall muscles often seen after pregnancy or significant weight gain and weight loss.  In the absence of a surgical history it is less likely, although not impossible, that this is a hernia.  An experienced surgeon (rather than a chiropractor or PT) is the best person to examine and determine your true diagnosis. Depending on your exam, a plan can be made for the best means of correction, which will involve repair of the muscles with or without removal of skin.  Good luck!

it's important to differentiate a hernia from a Diastais Recti. That said, I prefer to repair any diastasis recti At the same time as a concomitant hernia as I believe it improves the outcome of the hernia repair too. 

If you have a lot of extra loose skin, - tummy tuck by your plastic surgeon may help fix all of that. Otherwise, if not too much loose skin, I choose robotic-assisted laparoscopic surgery with hernia and tummy tuck done at the same time. Short recovery. Three little scars.